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This transition places biomarkers, particularly amyloid positron emission tomography (A\u03b2-PET), at the centre of diagnostic precision, patient selection, safety governance, and therapeutic monitoring. A\u03b2-PET provides high specificity for confirming cerebral amyloid pathology, especially in cases with discordant or inconclusive fluid biomarkers, and supports staging through semi-quantitative assessment using standardised Centiloid metrics. In patients considered for anti-amyloid therapies, baseline A\u03b2-PET refines eligibility and risk\u2013benefit profiling when integrated with MRI and APOE genotyping. During treatment, longitudinal A\u03b2-PET enables objective assessment of pharmacodynamic target engagement and treatment-related amyloid clearance, supporting response-adapted strategies and, in selected cases, therapy discontinuation. Beyond its clinical role, A\u03b2-PET has strategic organisational and economic implications. Its value is maximised when embedded within structured, stepwise diagnostic pathways that use scalable fluid biomarkers for triage and reserve A\u03b2-PET for high-impact decisions. However, implementation is challenged by regional heterogeneity, capacity constraints, and limited harmonisation across centres. Coordinated hub-and-spoke models, quantitative standardisation, and prospective registry-based data collection are essential to ensure the equitable and sustainable integration of anti-amyloid therapies into clinical practice. 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Marco Bozzali received speaker honoraria from Eli-Lilly, Eisai, Biogen, PIAM, Neopharmed Gentili; received compensation for consulting services from EISAI and GE Healthcare; took part in Advisory Boards for Eli-Lilly, Roche, Nono Nordisk. Annachiara Cagnin received speaker honoraria from Eli-Lilly, Eisai, Biogen, PIAM, Neopharmed Gentili, GE Healthcare, Novo Nordisk. Diego Cecchin has nothing to disclose. Arturo Chiti reports consulting or advisory role for Blue Earth Diagnostics, Telix Pharmaceuticals, InnovaRadi Therapeutic, and General Electric Healthcare; and Speaker\u2019s Bureaus for Bracco Diagnostics, General Electric Healthcare, Novartis, Telix Pharmaceuticals, and United Imaging; he is Editor in Chief of The EANM Journal. M. Filippi is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Neurological Sciences, and Radiology; received compensation for consulting services from Almirall, Biogen, Bristol-Myers Squibb, Eli Lilly, Merck, Novartis, Roche, Sanofi; speaking activities from Amgen, Bayer, Biogen, Bristol-Myers Squibb, Celgene, Chiesi Italia SpA, Eisai, Eli Lilly, Fujirebio, Genzyme, Janssen, Merck, Neopharmed Gentili, Neuraxpharm, Novartis, Novo Nordisk, Roche, Sanofi, Takeda; participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Eli Lilly, GE Healthcare Ltd, Merck, Neuraxpharm, Novartis, Roche, Sandoz, Sanofi, Takeda; scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi-Genzyme; he receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"This is a review article, and no ethical approval is required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"340"}}