Abstract
Purpose of Review
To critically examine the Coronary Artery Disease Reporting and Data System (CAD-RADS™) lexicon and its nuances, with representative case examples provided for each of the major CAD-RADS classification categories and modifiers.
Recent Findings
CAD-RADS is a recently developed multi-disciplinary, multi-society standardized reporting system for coronary CTA based on scientific data and expert consensus from leaders in cardiac imaging.
Summary
CAD-RADS was developed to improve quality and communication in cardiac imaging, and to provide management recommendations based on actionable information from the coronary CTA imaging report. Widespread adoption of CAD-RADS in clinical practice will help maximize the clinical impact of coronary CTA for the care of patients with acute and stable chest pain.
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References
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•• Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS, Budoff MJ, Dill KE, Jacobs JE, Maroules CD, Rubin GD, Rybicki FJ, Schoepf UJ, Shaw LJ, Stillman AE, White CS, Woodard PK, Leipsic JA. CAD-RADS(tm) coronary artery disease—reporting and data system. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. Journal of cardiovascular computed tomography. 2016;10:269–81. Original multisociety-endorsed paper describing the CAD-RADS lexicon with a detailed overview of assessment categories and modifiers.
Goldberg-Stein S, Walter WR, Amis ES, Jr., Scheinfeld MH. Implementing a structured reporting initiative using a collaborative multistep approach. Current problems in diagnostic radiology. 2016
Durack JC. The value proposition of structured reporting in interventional radiology. Am J Roentgenol. 2014;203:734–8.
Sickles EA, D’Orsi CJ, Bassett LW. ACR BI-RADS mammography. ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. American College of Radiology: Reston, VA; 2013.
Kazerooni EA, Armstrong MR, Amorosa JK, Hernandez D, Liebscher LA, Nath H, McNitt-Gray MF, Stern EJ, Wilcox PA. ACR CT accreditation program and the lung cancer screening program designation. J Am Coll Radiol. 2015;12:38–42.
Mitchell DG, Bruix J, Sherman M, Sirlin CB. LI-RADS (liver imaging reporting and data system): summary, discussion, and consensus of the LI-RADS Management Working Group and future directions. Hepatology. 2015;61:1056–65.
Lee B, Whitehead MT. Radiology reports: What you think you’re saying and what they think you’re saying. Current problems in diagnostic radiology. 2016.
Ghoshhajra BB, Lee AM, Ferencik M, Elmariah S, Margey RJ, Onuma O, Panagia M, Abbara S, Hoffmann U. Interpreting the interpretations: the use of structured reporting improves referring clinicians’ comprehension of coronary CT angiography reports. J Am Coll Radiol. 2013;10:432–8.
Leipsic J, Abbara S, Achenbach S, Cury R, Earls JP, Mancini GJ, Nieman K, Pontone G, Raff GL. SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. Journal of cardiovascular computed tomography. 2014;8:342–58.
Abbara S, Blanke P, Maroules CD, Cheezum M, Choi AD, Han BK, Marwan M, Naoum C, Norgaard BL, Rubinshtein R, Schoenhagen P, Villines T, Leipsic J. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee: endorsed by the North American Society for Cardiovascular Imaging (NASCI). Journal of cardiovascular computed tomography. 2016;10:435–49.
Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King 3rd SB, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith Jr CR, Smith Jr SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60:e44–e164.
Cheruvu C, Precious B, Naoum C, Blanke P, Ahmadi A, Soon J, Arepalli C, Gransar H, Achenbach S, Berman DS, Budoff MJ, Callister TQ, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Rubinshtein R, Marquez H, DeLago A, Villines TC, Hadamitzky M, Hausleiter J, Shaw LJ, Kaufmann PA, Cury RC, Feuchtner G, Kim YJ, Maffei E, Raff G, Pontone G, Andreini D, Chang HJ, Min JK, Leipsic J. Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: results from the 5 year follow-up of the CONFIRM International Multicenter Registry. Journal of cardiovascular computed tomography. 2016;10:22–7.
Schlett CL, Banerji D, Siegel E, Bamberg F, Lehman SJ, Ferencik M, Brady TJ, Nagurney JT, Hoffmann U, Truong QA. Prognostic value of CT angiography for major adverse cardiac events in patients with acute chest pain from the emergency department: 2-year outcomes of the ROMICAT trial. JACC Cardiovascular imaging. 2011;4:481–91.
Ahmadian HR, Thomas DM, Shaw DJ, Barnwell ML, Jones RL, McDonough RJ, Prentice RL, Lin CK, Slim AM. Effect of coronary computed tomography angiography disease burden on the incidence of recurrent chest pain. Int Sch Res Notices. 2014;2014:304825.
Raff GL, Chinnaiyan KM, Cury RC, Garcia MT, Hecht HS, Hollander JE, O’Neil B, Taylor AJ, Hoffmann U. SCCT guidelines on the use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. Journal of cardiovascular computed tomography. 2014;8:254–71.
Maurovich-Horvat P, Ferencik M, Voros S, Merkely B, Hoffmann U. Comprehensive plaque assessment by coronary CT angiography. Nat Rev Cardiol. 2014;11:390–402.
van Velzen JE, de Graaf FR, de Graaf MA, Schuijf JD, Kroft LJ, de Roos A, Reiber JHC, Bax JJ, Jukema JW, Boersma E, Schalij MJ, van der Wall EE. Comprehensive assessment of spotty calcifications on computed tomography angiography: comparison to plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis. J Nucl Cardiol. 2011;18:893–903.
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This article is part of the Topical Collection on Cardiac Computed Tomography
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Supplementary Figure 1
Process for applying CAD-RADS in clinical practice. (JPEG 61 kb)
Supplementary Figure 2
CAD-RADS 0. Curved multi-planar reformat images of the RCA (left), LAD (middle), and LCX (right) demonstrating absence of coronary plaque and no stenosis. The major coronary branch vessels measuring >1.5 mm in diameter (not shown) were also normal with no plaque or stenosis. (JPEG 163 kb)
Supplementary Figure 3
Curved multi-planar reformat image (left) and axial image (right) demonstrating motion artifact which obscures the proximal and mid-RCA segments (arrows). Evaluation of the RCA on other reconstructed phases demonstrated a similar artifact. Non-obstructive plaque was present in the proximal LAD (25–49% stenosis) and in the mid-LCX (less than 25% stenosis). The other coronary segments were normal. Since the visualized coronary segments were significant for only non-obstructive plaque with less than 50% stenosis, this case would be coded CAD-RADS N, with “N” used as an assessment category. Contrarily, if there were moderate stenosis in the proximal LAD (50–69%), this case would be coded as CAD-RADS 3/N, with “N” used as a modifier. (JPEG 84 kb)
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Maroules, C.D., Goerne, H., Abbara, S. et al. Improving Quality and Communication in Cardiac Imaging: The Coronary Artery Disease Reporting and Data System (CAD-RADS™). Curr Cardiovasc Imaging Rep 10, 20 (2017). https://doi.org/10.1007/s12410-017-9417-1
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DOI: https://doi.org/10.1007/s12410-017-9417-1