Moving towards a uniform diagnosis of coronary artery disease on coronary CTA : Coronary Artery Disease-Reporting and Data System 2.0

Abstract

The Coronary Artery Disease-Reporting and Data System (CAD-RADS) is a standardised reporting method which was created in order to improve communication with referring physicians as well as for management considerations. The CAD-RADS score denotes the absence or presence of stenosis, while plaque burden and potential modifiers provide insight into plaque extent and characteristics. The modifier ischaemia enables the incorporation of fractional flow reserve CT and CT perfusion, while the modifier exception is used to denote potential coronary abnormalities. Higher CAD-RADS categories demonstrate incremental prognostic value, with further improvement when taking plaque burden into account. CAD-RADS improves communication with the referring clinician as well as guiding therapeutic management and as such is relevant to uniform patient care in the Netherlands.

Keywords: Atherosclerosis; Coronary artery disease; Multidetector computed tomography; Risk management.

Fig. 1

Infographic: Uniform reporting of coronary CT

Fig. 2

CAD-RADS categories: CAD-RADS stenosis degree with CCTA examples. LAD left anterior descending, RCA right coronary artery

Fig. 3

CAD-RADS modifiers: a low-attenuation plaque; b plaque with positive remodelling and napkin-ring sign; c semi-automated assessment of plaque composition; d spotty calcifications (< 3 mm); e computed tomography perfusion image with perfusion defect (white arrow) in the territory of LAD; f fractional-flow reserve (FFR) CT with haemodynamic significant stenosis in the LAD and RCA. HRP high-risk plaque, LAD left anterior descending, RCA right coronary artery