Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Apr;28(4):1365-1372.
doi: 10.1007/s00330-017-5105-4. Epub 2017 Nov 7.

CAD-RADS - a new clinical decision support tool for coronary computed tomography angiography

Borek Foldyna  1   2 , Bálint Szilveszter  3 , Jan-Erik Scholtz  4 , Dahlia Banerji  4 , Pál Maurovich-Horvat  3 , Udo Hoffmann  4
Affiliations
Review

CAD-RADS - a new clinical decision support tool for coronary computed tomography angiography

Borek Foldyna et al. Eur Radiol. 2018 Apr.

Abstract

Coronary computed tomography angiography (CTA) has been established as an accurate method to non-invasively assess coronary artery disease (CAD). The proposed 'Coronary Artery Disease Reporting and Data System' (CAD-RADS) may enable standardised reporting of the broad spectrum of coronary CTA findings related to the presence, extent and composition of coronary atherosclerosis. The CAD-RADS classification is a comprehensive tool for summarising findings on a per-patient-basis dependent on the highest-grade coronary artery lesion, ranging from CAD-RADS 0 (absence of CAD) to CAD-RADS 5 (total occlusion of a coronary artery). In addition, it provides suggestions for clinical management for each classification, including further testing and therapeutic options. Despite some limitations, CAD-RADS may facilitate improved communication between imagers and patient caregivers. As such, CAD-RADS may enable a more efficient use of coronary CTA leading to more accurate utilisation of invasive coronary angiograms. Furthermore, widespread use of CAD-RADS may facilitate registry-based research of diagnostic and prognostic aspects of CTA.

Key points: • CAD-RADS is a tool for standardising coronary CTA reports. • CAD-RADS includes clinical treatment recommendations based on CTA findings. • CAD-RADS has the potential to reduce variability of CTA reports.

Keywords: Classification; Computed tomography angiography; Coronary artery disease; Coronary stenosis; Percutaneous coronary intervention.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Common mistakes in CAD-RADS classification
A: mild stenosis in the proximal RCA with a non-diagnostic mid RCA segment due to severe motion artifacts. In the case of minimal to mild stenoses but non-diagnostic remote segments, CTA cannot appropriately guide further management. Hence, here the proper CAD-RADS category is “N” and not “2/N”. B: tandem LM and LAD lesions with high-risk plaque features. In this case, the modifier “V” would be incorrect because both high-risk plaque features are distributed throughout multiple lesions and do not belong to one distinct lesion. C: stenosis treated by a CABG. The severe distal LAD stenosis proximally to the LIMA graft should not be considered for stenosis classification, since the LIMA graft is patent. CABG = coronary artery bypass graft; LAD = left anterior descending; LIMA = left internal mammary artery; LV = left ventricle; RCA = right coronary artery; RV = right ventricle.
Figure 2
Figure 2. Summary–print out
Workflow and classification summary for the individual work space.
See this image and copyright information in PMC

References

    1. Cury RC. President’s page: Ten years of innovation in cardiac CT. J Cardiovasc Comput Tomogr. 2014;8:338–339. doi: 10.1016/j.jcct.2014.07.006. - DOI - PubMed
    1. Douglas PS, Hoffmann U, Patel MR, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015;372:1291–1300. doi: 10.1056/NEJMoa1415516. - DOI - PMC - PubMed
    1. Hoffmann U, Ferencik M, Udelson JE, et al. Prognostic Value of Noninvasive Cardiovascular Testing in Patients with Stable Chest Pain: Insights from the PROMISE Trial. Circulation. 2017 doi: 10.1161/CIRCULATIONAHA.116.024360. - DOI - PMC - PubMed
    1. Rybicki FJ, Udelson JE, Peacock WF, et al. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Cardiol. 2016;67:853–879. doi: 10.1016/j.jacc.2015.09.011. - DOI - PubMed
    1. Guidance and guidelines. NICE; [Accessed 19 Apr 2017]. Chest pain of recent onset: assessment and diagnosis. https://www.nice.org.uk/guidance/cg95.