SCCT Issues CAD-RADS 2.0 Expert Consensus Document

July 7, 2022—The Society of Cardiovascular Computed Tomography (SCCT) announced the release of the new Coronary Artery Disease—Reporting and Data System (CAD-RADS) expert consensus document, which SCCT issued in collaboration with the American College of Cardiology, American College of Radiology, and North America Society of Cardiovascular Imaging.

According to SCCT, the new CAD-RADS 2.0 expands on the first version, which was created in 2016 to standardize a reporting system for patients undergoing coronary CTA and guide possible next steps in patient management. The collaboration was led by Ricardo Cury, MD, and Ron Blankstein, MD, with a goal to update and improve the initial 2016 reporting system for coronary CTA by incorporating the latest technical developments as well as recent clinical trials and guidelines in cardiac CT.

The document was published by Dr. Cury et al online in Journal of Cardiovascular Computed Tomography.

In the SCCT press release, Dr. Blankstein commented, “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.”

The SCCT press release further explained that the updated classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of CT fractional flow reserve (CT-FFR) or myocardial CT perfusion, when performed.

One key update provided in the CAD-RADS 2.0 statement is that plaque burden should be estimated whenever present. This can be accomplished using an evaluation of the amount of coronary artery calcium (if performed), segment involvement score, a visual assessment, or total plaque burden quantification, when available and validated.

Based on these methods, the overall amount of plaque descriptor ranges from P1 to P4 (mild, moderate, severe, extensive) to denote increasing categories of plaque burden.

Two new modifiers were also added: modifier I (ischemia) indicating that an ischemia test with CT has been performed (either CT-FFR or stress CT perfusion) and whether the result was positive (+), negative (-) or borderline (+/-) and modifier E (exceptions) to denote the presence of nonatherosclerotic narrowing of the coronary arteries.

Along with significant updates, some consistencies remain from the original guideline and were emphasized in the 2.0 version. These consistencies include that the stenosis severity classification remains the same, 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 advised that CAD-RADS classification should always be interpreted together with the impression found in the report.

Dr. Cury commented in the SCCT press release, “I am pleased and humbled to have worked with an expert group of leaders in the field of cardiology, radiology, and cardiac imaging to improve and expand the updated CAD-RADS 2.0 document considering recent clinical trials, new guidelines, and increasing data supporting the prognostic relevance of coronary plaque burden and physiologic assessment by cardiac CT.”

Because of this important update, 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, stressed Dr. Cury in the press release.