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)

Ricardo C Cury; Jonathon Leipsic; Suhny Abbara; Stephan Achenbach; Daniel Berman; Marcio Bittencourt; Matthew Budoff; Kavitha Chinnaiyan; Andrew D Choi; Brian Ghoshhajra; Jill Jacobs; Lynne Koweek; John Lesser; Christopher Maroules; Geoffrey D Rubin; Frank J Rybicki; Leslee J Shaw; Michelle C Williams; Eric Williamson; Charles S White; Todd C Villines; Ron Blankstein

doi:10.1016/j.jcmg.2022.07.002

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)

JACC Cardiovasc Imaging. 2022 Nov;15(11):1974-2001. doi: 10.1016/j.jcmg.2022.07.002. Epub 2022 Sep 14.

Authors

Ricardo C Cury¹, Jonathon Leipsic², Suhny Abbara³, Stephan Achenbach⁴, Daniel Berman⁵, Marcio Bittencourt⁶, Matthew Budoff⁷, Kavitha Chinnaiyan⁸, Andrew D Choi⁹, Brian Ghoshhajra¹⁰, Jill Jacobs¹¹, Lynne Koweek¹², John Lesser¹³, Christopher Maroules¹⁴, Geoffrey D Rubin¹⁵, Frank J Rybicki¹⁶, Leslee J Shaw¹⁷, Michelle C Williams¹⁸, Eric Williamson¹⁹, Charles S White²⁰, Todd C Villines²¹, Ron Blankstein²²

Affiliations

¹ Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida, USA. Electronic address: rcury@baptisthealth.net.
² Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
³ Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA.
⁴ Friedrich-Alexander-Universität, Department of Cardiology, Erlangen, Germany.
⁵ Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁶ Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁷ David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
⁸ Beaumont Hospital, Royal Oak, Michigan, USA.
⁹ The George Washington University School of Medicine, Washington, DC, USA.
¹⁰ Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹¹ NYU Langone Medical Center, New York, New York, USA.
¹² Department of Radiology, Duke University, Durham, North Carolina, USA.
¹³ Division of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA.
¹⁴ Department of Radiology, Naval Medical Center, Portsmouth, Virginia, USA.
¹⁵ Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA.
¹⁶ Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
¹⁷ Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹⁸ University of Edinburgh, Edinburgh, United Kingdom.
¹⁹ Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
²⁰ University of Maryland, College Park, Maryland, USA.
²¹ Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA.
²² Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: rblankstein@bwh.harvard.edu.

PMID: 36115815
DOI: 10.1016/j.jcmg.2022.07.002

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.

Keywords: CAD-RADS; coronary CTA; coronary artery disease; ischemia; plaque burden; report standardization terminology; reporting and data system; stenosis severity.

Publication types

Practice Guideline

MeSH terms

Artificial Intelligence
Cardiology*
Computed Tomography Angiography
Consensus
Constriction, Pathologic
Coronary Angiography / methods
Coronary Artery Disease* / diagnostic imaging
Coronary Artery Disease* / therapy
Coronary Stenosis* / diagnostic imaging
Coronary Stenosis* / therapy
Humans
Plaque, Atherosclerotic*
Predictive Value of Tests
Radiology*
United States

Grants and funding

FS/ICRF/20/26002/BHF_/British Heart Foundation/United Kingdom