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)

Abstract

Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in Cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care.

The role of coronary CTA and CT‐fractional flow reserve evaluating coronary artery disease in transcatheter aortic valve replacement

“…If a good‐quality CCTA study demonstrates a coronary lesion with 50% luminal narrowing or greater, images are sent to the HeartFlow™ platform for analysis with CT‐FFR quantification. These guidelines are in concert with the 2021 American College of Cardiology and American Heart Association Guideline for the Evaluation and Diagnosis of Chest Pain as well as the Coronary Artery Disease Reporting and Data System 2.0 released by the Society of Cardiovascular Computed Tomography in July 2022 5,6 . Utilizing artificial intelligence algorithms and computational fluid dynamics, the HeartFlow™ platform provides quick and reliable turnover thus facilitating a timely multidisciplinary review and surgical planning.…”

“…[1][2][3][4] The current workflow at our institution for TAVI evaluation includes a CTA TAVR protocol of the chest abdomen and pelvis, as well as a focused full spectrum CCTA with parameters for assessment of the aortic root and coronary arteriosclerosis. These imaging orders are placed concurrently when the patient comes in for initial 5,6 Utilizing artificial intelligence algorithms and computational fluid dynamics, the HeartFlow™ platform provides quick and reliable turnover thus facilitating a timely multidisciplinary review and surgical planning.…”

Multimodality Imaging of Sudden Cardiac Death and Acute Complications in Acute Coronary Syndrome

“…Considering the impact of plaque characteristics and coronary artery stenosis in terms of prognosis, the reporting system of CCTA has been modified, taking into account that both metrics can be useful in terms of diagnosis and prognosis [ 161 , 162 , 163 ]; especially considering that patients after CCTA, beyond invasive coronary angiography, could be potentially treated with aggressive medical therapy [ 161 ].…”

Interpreting the Interpretation

“…Another example of this approach that impacts cardiovascular imaging specialists, is the CAD-RADS (Coronary Artery Disease Reporting and Data System) standardized method for communicating findings and clinical follow up recommendations for cardiac computed tomography (just recently updated to CAD-RADS 2.0). 2 Using this approach, the individual reading the interpretation is provided short management recommendations, such as “CAD-RADS 0: Consider non-atherosclerotic causes of chest pain” or “CADS-RADS 4: Consider symptom-guided anti-ischemic and preventive pharmacotherapy as well as risk factor modifications.” This effort was driven by the fact that it is how clinicians act on the test results that will ultimately impact patient care and clinical outcomes.…”