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Despite advances in diagnosis, prognosis remains highly heterogeneous, encompassing risks of recurrent hemorrhage and progressive cognitive decline. This review summarizes recent developments in imaging and fluid biomarkers for prognostic stratification in CAA. Imaging markers, including advanced MRI and molecular PET techniques, have evolved from traditional hemorrhagic indicators, such as cerebral micro-bleeds (CMBs) and cortical superficial siderosis (cSS), to non-hemorrhagic including white matter hyper-intensities (WMHs), and enlarged perivascular spaces (ePVS), which sensitively capture microstructural damage after using quantitative measures. Fluid biomarkers provide dynamic insights into vascular and neuronal injury, including altered plasma A\u03b242\/A\u03b240 ratios, MMPs\/TIMPs balance, and elevated neuro-filament light chain (NfL) and glial fibrillary acidic protein (GFAP) levels. Integrating these multi-modal indicators may enable individualized prediction of hemorrhagic and cognitive outcomes and inform precision management strategies. Future research should standardize quantification methods and validate multi-modal models across diverse CAA phenotypes to advance toward personalized prognostic frameworks.<\/jats:p>","DOI":"10.1007\/s00415-026-13626-2","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T02:41:59Z","timestamp":1768963319000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Imaging and fluid biomarkers for prognostic stratification in cerebral amyloid angiopathy"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6836-0705","authenticated-orcid":false,"given":"Dandan","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuxian","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqing","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingquan","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"13626_CR1","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1177\/17474930251365861","volume":"20","author":"C Cordonnier","year":"2025","unstructured":"Cordonnier C, Klijn C, Smith EE, Al-Shahi Salman R, Chwalisz BK, van Etten E et al (2025) Diagnosis and management of cerebral amyloid angiopathy: a scientific statement from the international caa association and the world stroke organization. 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