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

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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.

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Fig. 1
Fig. 2

Abbreviations

ACS :

Acute coronary syndrome

AHA :

American HeartAssociation

CABG :

Coronary artery bypass graft

CAD :

Coronary artery disease

CAD-RADS :

Coronary artery disease – Reporting and Data System

CT :

Computed tomography

CTA :

Computed tomography angiography

FFR :

Fractional flow reserve

HU :

Hounsfield units

LAD :

Left anterior descending

LM :

Left main

NICE :

National Institute for Health and Care Excellence

RCA :

Right coronary artery

SCCT :

Society of Cardiovascular Computed Tomography

TIMI :

Thrombolysis in myocardial infarction

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Acknowledgements

Borek Foldyna received funding from the German Research Foundation (DFG), project 290004377 (FO 993/1).

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA

    Borek Foldyna, Jan-Erik Scholtz, Dahlia Banerji & Udo Hoffmann

  2. Department of Diagnostic and Interventional Radiology, University of Leipzig – Heart Center, Leipzig, Germany

    Borek Foldyna

  3. MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary

    Bálint Szilveszter & Pál Maurovich-Horvat

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  1. Borek Foldyna
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  2. Bálint Szilveszter
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  3. Jan-Erik Scholtz
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  5. Pál Maurovich-Horvat
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Correspondence to Borek Foldyna.

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The scientific guarantor of this publication is Borek Foldyna, MD.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

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Written informed consent was obtained from all three patients for the anonymised image data use.

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Foldyna, B., Szilveszter, B., Scholtz, JE. et al. CAD-RADS – a new clinical decision support tool for coronary computed tomography angiography. Eur Radiol 28, 1365–1372 (2018). https://doi.org/10.1007/s00330-017-5105-4

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