The Society of Cardiovascular Computed Tomography (SCCT), in collaboration with the ACC, the American College of Radiology and the North America Society of Cardiovascular Imaging, has published a new expert consensus document on Coronary Artery Disease – Reporting and Data System (CAD-RADS 2.0) aimed at standardizing the reporting system for patients undergoing coronary CT angiography (CCTA) and guiding possible next steps in patient management.

The document, led by Ricardo C. Cury, MD, MBA, FACC, and Ron Blankstein, MD, FACC, updates and expands on the first version created in 2016 based on the latest technical developments and recent clinical trials and guidelines in CCTA. The document outlines an established framework of stenosis, plaque burden and modifiers, and includes assessment of CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed.

Highlights from the CAD-RADS 2.0 document include a recommendation to estimate plaque burden whenever present, using either an evaluation of the amount of coronary artery calcium, segment involvement score, a visual assessment, or total plaque burden quantification, when available and validated.

The document also includes the addition of two new modifiers: 1) Modifier I (ischemia) indicating that an ischemia test with CT has been performed (either CT-FFR or stress CTP) and if the result was positive (+), negative (-) or borderline (+/-); and 2) Modifier E (exceptions) to denote the presence of non-atherosclerotic narrowing of the coronary arteries.

Along with these and other updates, the authors note that some consistencies remain from the original version, and are emphasized in the 2.0 version, including the stenosis severity classification, ranging from CAD-RADS 0 for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one 100% occluded vessel. The authors also stress that CAD-RADS classification should always be interpreted together with the impression found in the report.

"Even though coronary CTA can be a very useful test when performed on the right patient population, the test itself does not change outcomes. Rather, it is how clinicians act on the test results that ultimately makes a difference. For this reason, it is essential to provide referring clinicians with patient management recommendations which are now part of the CAD-RADS 2.0 statement," says Blankstein.

In addition to supporting clinicians with patient management, Cury also notes that the updated document has the added continued benefit of offering a standardized framework to support education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance into the future.

Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Statins, Interventions and Coronary Artery Disease, Interventions and Imaging, Computed Tomography, Nuclear Imaging

Keywords: Computed Tomography Angiography, Coronary Artery Disease, Calcium, Cytidine Triphosphate, Consensus, Artificial Intelligence, Constriction, Pathologic, Fractional Flow Reserve, Myocardial, Radiology, Population Health, North America, Perfusion, Ischemia

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