ECR 2023, Vienna, Austria, 1 - 05 March 2023, pp.1-8
Purpose or Learning Objective
To describe CAD-RADS 2.0 classification system and highlight the differences from the first version.
Methods or Background
Coronary CT angiography (CCTA) is the primary imaging modality to assess symptomatic patients with stable symptoms, intermediate-risk acute chest pain and intermediate or high pre-test probability of obstructive coronary disease. Coronary Artery Disease - Reporting and Data System (CAD-RADS) was first released in 2016 to standardize reporting of the CCTA (1). CAD-RADS 2.0 is published in July 2022 and aims to improve the first reporting system under the guidance of new guidelines and technical developments .The updated 2022 CAD-RADS 2.0 classification will follow a framework of stenosis, plaque burden and modifiers, with the option to also include ischemia evaluation by CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), if performed. As in the original version, the most severe coronary artery luminal stenosis defined on a per-patient basis will be the central component of assessment and will provide the numeric descriptor. In addition, methods to estimate, quantify and report overall plaque burden will be provided. Collectively, the goal of these additions is intended to enhance patient management decisions following CCTA.(2).
Results or Findings
The First CAD-RADS classification was focused on the stenosis grading and 4 complementary modifiers were described: N( non-diagnostic), S (stent), G (graft), and V ( vulnerability).On CAD-RADS 2.0; stenosis grading , N-S and G modifiers remain the same. Describing a grading scale for plaque burden is the main addition to the first version. There are also two new modifiers; I+, I- and I± (ischemia), and E (exceptions). V modifier becomes HRP (high-risk plaque) .Stenosis grading ranges from CAD-RADS 0 ( no visible stenosis) to CAD-RADS 5 (at least one occluded vessel).Plaque burden can be determined by Coronary Artery Calcium testing , Segment İnvolvement Score or visual estimation and it ranges from P1 (mild) to P4 (extensive). P1 (mild) refers to 1-2 vessels with mild amount of plaque (Fig.1-2). P2 (moderate) is used for 1-2 vessels with moderate or 3 vessels with mild amount of plaque (Fig.3). P3 (severe) refers to 3 vessels with moderate amount or 1 vessel with severe amount of plaque. P4 (extensive) is known for 2 or 3 vessels with severe amount of plaque (Fig 4,5). “İ" indicates lesion specific ischemia or reversible perfusion defect detected by Computed tomography fractional flow reserve (CT-FFR) or computed tomography perfusion (CTP). “E” is used for non- atherosclerotic causes of coronary abnormalities (Fig.6).