CAD-RADS 2.0: What We Need to Know

Congress:

ECR 2023

Poster Number:

C-17912

Type:

Educational Exhibit

Keywords:

Cardiac, CT-Angiography, CAD, Education and training

Authors:

R. C. Yarol, M. M. M. Bariş

DOI:

10.26044/ecr2023/C-17912

DOI-Link:

https://dx.doi.org/10.26044/ecr2023/C-17912

Learning objectives

To describe CAD-RADS 2.0 classification system and highlight the differences from the first version.

Background

Coronary CT angiography (CCTA) is the primary imaging modality to assess symptomatic patients with stable symptoms, intermediate-risk acute chest pain and intermediate or high pre-test probability of obstructive coronary disease. Coronary Artery Disease - Reporting and Data System (CAD-RADS) was first released in 2016 to standardize reporting of the CCTA (1). CAD-RADS 2.0 is published in July 2022 and aims to improve the first reporting system under the guidance of new guidelines and technical developments .The updated 2022 CAD-RADS 2.0 classification will follow a framework...

Findings and procedure details

The First CAD-RADS classification was focused on the stenosis grading and 4 complementary modifiers were described: N( non-diagnostic), S (stent), G (graft), and V ( vulnerability).On CAD-RADS 2.0; stenosis grading , N-S and G modifiers remain the same. Describing a grading scale for plaque burden is the main addition to the first version. There are also two new modifiers; I+, I- and I± (ischemia), and E (exceptions). V modifier becomes HRP (high-risk plaque) (Fig.7).Stenosis grading ranges from CAD-RADS 0 ( no visible stenosis) to CAD-RADS...

Conclusion

CAD-RADS 2.0 has some significant differences from the first version and every radiologist who reports CCTA should be aware of these updates.

Personal information and conflict of interest

R. C. Yarol: Nothing to disclose M. M. M. Bariş: Nothing to disclose

References

1- Cury, Ricardo C., et al. "Coronary Artery Disease-Reporting and Data System (CAD-RADS) An Expert Consensus Document of SCCT, ACR and NASCI: Endorsed by the ACC." JACC: cardiovascular imaging9.9 (2016): 1099-1113. 2- Cury, Ricardo C., et al. "CAD-RADS™ 2.0–2022 Coronary Artery Disease-Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and the North America Society of Cardiovascular Imaging (NASCI)."Cardiovascular Imaging15.11 (2022): 1974-2001.

Fig 1: CAD-RADS 1, P1. Normal RCA and LCx. Mild disease (<%25) in proximal LAD.

Fig 2: CAD- RADS 1, P1. Mild disease (<%25) in proximal LAD and LM artery . No other...

Fig 3: CAD-RADS 3,P2. Moderate disease (%50-69) in proximal LAD. Mild disease (<%25)...

Fig 4: CAD-RADS 4, P4. Moderate disease in LAD. Extensive amount of plaque in RCA, LAD...

Fig 5: CAD-RADS 5, P4. Occluded segment in RCA. Extensive amount of plaque in RCA,LAD...

Fig 6: CAD-RADS 4, P1, E (ANEURYSM). LAD aneurysm, severe stenosis in LAD (%70). No...

Fig 7: CAD- RADS 4, P4, HRP. High risk plaque and severe stenosis in LAD . Extensive...

Fig 8: CAD- RADS vs CAD- RADS 2.0

Fig 9: Degree of stenosis terminology

Fig 10: Plaque burden classification

Fig 11: E: Exceptions