CAD-RADS

Coronary Artery Disease Reporting and Data System v2.0

Standardized reporting of coronary CT angiography by maximal stenosis, plaque burden, ischemia and modifiers.

vigenteSCCT / ACC / ACR / NASCI2.02022CT

00 percent, no plaque 11 to 24 percent, minimal 225 to 49 percent, mild 350 to 69 percent, moderate 4A70 to 99 percent in 1 or 2 vessels, severe 4BLeft main 50 percent or more, or 3-vessel obstructive disease 5100 percent, total occlusion P1Plaque burden P1, mild P2Plaque burden P2, moderate P3Plaque burden P3, severe P4Plaque burden P4, extensive NModifier N, non-diagnostic study HRPModifier HRP, high-risk plaque I+Modifier I+, positive ischemia I-Modifier I-, negative ischemia I+/-Modifier I+/-, borderline or indeterminate ischemia SModifier S, coronary stent present GModifier G, coronary bypass graft present EModifier E, non-atherosclerotic exception

Aplicar o CAD-RADS a um achado

Descreva o achado como no laudo. A resposta aponta uma das categorias publicadas, com a probabilidade e o trecho que a decide.

Categorias

Reescritas a partir da fonte e citadas

1 de 19

0 percent, no plaque

0% maximal coronary stenosis - no plaque and no luminal stenosis (absence of coronary atherosclerosis).

CondutaReassurance; consideration of non-atherosclerotic causes of symptoms; preventive measures / risk-factor management as clinically appropriate.

RiscoNo coronary atherosclerosis.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 stenosis categories table (CAD-RADS 0 row), per-patient maximal stenosis

2 de 19

1 to 24 percent, minimal

1-24% maximal coronary stenosis - minimal stenosis or plaque with no stenosis.

CondutaEmphasis on preventive therapy and risk-factor modification; generally no further cardiac testing for the stenosis itself.

RiscoMinimal coronary stenosis.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 stenosis categories table (CAD-RADS 1 row)

3 de 19

25 to 49 percent, mild

25-49% maximal coronary stenosis - mild stenosis.

CondutaPreventive therapy and risk-factor modification; considered non-obstructive, so no specific ischemia work-up is mandated for the stenosis alone.

RiscoMild, non-obstructive coronary stenosis.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 stenosis categories table (CAD-RADS 2 row)

4 de 19

50 to 69 percent, moderate

50-69% maximal coronary stenosis - moderate stenosis.

CondutaConsideration of functional/ischemia assessment (e.g. CT-FFR, myocardial CT perfusion, stress testing) or invasive coronary angiography (ICA) when ischemia evaluation is needed; preventive therapy.

RiscoModerate stenosis, potentially obstructive.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 stenosis categories table (CAD-RADS 3 row)

5 de 19

70 to 99 percent in 1 or 2 vessels, severe

70-99% maximal coronary stenosis (severe) in 1 or 2 vessels, without left main involvement or 3-vessel obstructive disease.

CondutaConsideration of ICA and/or functional imaging (e.g. CT-FFR, myocardial CT perfusion, stress testing); preventive therapy and risk-factor modification.

RiscoSevere, obstructive stenosis limited to 1 or 2 vessels.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 stenosis categories table (CAD-RADS 4A row), per-patient maximal stenosis

6 de 19

Left main 50 percent or more, or 3-vessel obstructive disease

Left main stenosis >=50% OR 3-vessel obstructive disease (>=70% stenosis in each of three vessels).

CondutaICA recommended, with possible revascularization, particularly in symptomatic patients; this higher-risk anatomy is managed more aggressively than 4A.

RiscoSevere stenosis with higher-risk anatomy (left main or 3-vessel obstructive disease).

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 stenosis categories table (CAD-RADS 4B row), per-patient maximal stenosis

7 de 19

100 percent, total occlusion

100% stenosis - total coronary occlusion of at least one coronary artery (i.e. >99% / complete occlusion).

CondutaConsideration of ICA and/or viability assessment; evaluate whether the occlusion is acute versus chronic and assess collateralization, guiding possible revascularization.

RiscoTotal coronary occlusion.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 stenosis categories table (CAD-RADS 5 row)

8 de 19

Plaque burden P1, mild

Mild overall coronary plaque burden on a per-patient basis: CAC 1-100; SIS <=2; or visual estimation of a mild amount of plaque in 1-2 vessels. CAD-RADS 0 denotes no plaque, so P0 is not used.

CondutaReport P1 after the stenosis category and interpret it with the full impression and clinical context. CAD-RADS 2.0 does not define an absolute treatment threshold from the P category alone.

RiscoMild total coronary plaque burden; plaque burden contributes prognostic information beyond stenosis severity alone.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 section 3.2.1 and Table 2 (P1 row); Tables 4-5 for management context

9 de 19

Plaque burden P2, moderate

Moderate overall coronary plaque burden on a per-patient basis: CAC 101-300; SIS 3-4; or visual estimation of a moderate amount of plaque in 1-2 vessels or a mild amount in 3 vessels.

CondutaReport P2 after the stenosis category. A higher plaque burden may support more intensive preventive therapy consideration, but CAD-RADS 2.0 states that P categories are not absolute treatment thresholds and should be integrated with the impression and clinical context.

RiscoModerate total coronary plaque burden; increasing plaque burden is associated with increasing cardiovascular risk independently of stenosis severity.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 section 3.2.1 and Table 2 (P2 row); Tables 4-5 for management context

10 de 19

Plaque burden P3, severe

Severe overall coronary plaque burden on a per-patient basis: CAC 301-999; SIS 5-7; or visual estimation of a moderate amount of plaque in 3 vessels or a severe amount in 1 vessel.

CondutaReport P3 after the stenosis category. A higher plaque burden may support more intensive preventive therapy consideration, but CAD-RADS 2.0 states that P categories are not absolute treatment thresholds and should be integrated with the impression and clinical context.

RiscoSevere total coronary plaque burden; increasing plaque burden is associated with increasing cardiovascular risk independently of stenosis severity.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 section 3.2.1 and Table 2 (P3 row); Tables 4-5 for management context

11 de 19

Plaque burden P4, extensive

Extensive overall coronary plaque burden on a per-patient basis: CAC >1000; SIS >=8; or visual estimation of a severe amount of plaque in 2-3 vessels.

CondutaReport P4 after the stenosis category. A higher plaque burden may support more intensive preventive therapy consideration, but CAD-RADS 2.0 states that P categories are not absolute treatment thresholds and should be integrated with the impression and clinical context.

RiscoExtensive total coronary plaque burden; increasing plaque burden is associated with increasing cardiovascular risk independently of stenosis severity.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 section 3.2.1 and Table 2 (P4 row); Tables 4-5 for management context

12 de 19

Modifier N, non-diagnostic study

Non-diagnostic study or segment. If a diagnostic segment contains stenosis >=50%, retain the numeric CAD-RADS category and append N; if interpretable segments show at most 25-49% stenosis and at least one segment >1.5 mm is non-interpretable, N replaces the numeric category. Add P when total plaque burden remains reliably assessable.

CondutaFurther evaluation is required when N replaces the numeric category because significant stenosis cannot be reliably excluded. When a diagnostic segment already establishes CAD-RADS >=3, append N and base downstream considerations on the demonstrated disease plus the residual uncertainty.

RiscoN represents diagnostic uncertainty rather than a stenosis-severity or event-risk grade.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 section 3.3.1 (Modifier N) and Figures 11-12

HRP

13 de 19

Modifier HRP, high-risk plaque

Add HRP when a single coronary plaque clearly demonstrates at least 2 high-risk features: positive remodeling (remodeling index >1.1), low-attenuation plaque (<30 HU), spotty calcification, or napkin-ring sign. Describe the specific features in the report text.

CondutaDo not use HRP in isolation to mandate invasive angiography. Integrate symptoms, stenosis, plaque burden, ischemia testing and the full clinical context; more aggressive preventive management may be considered in appropriate patients.

RiscoHRP features are associated with higher risk of acute coronary syndrome, future adverse cardiovascular events and lesion-specific ischemia, but their positive predictive value is modest when considered alone.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 section 3.3.4 (High-risk plaque), Figures 15-16 and management discussion

I+

14 de 19

Modifier I+, positive ischemia

Positive lesion-specific ischemia: CT-FFR <=0.75 in a vessel large enough for PCI, or myocardial CT perfusion showing reversible ischemia or peri-infarct ischemia.

CondutaIn a symptomatic patient and an appropriate revascularization context, I+ may support consideration of invasive coronary angiography; integrate lesion location, symptoms, anatomy and all available imaging or stress-test findings.

RiscoImaging evidence of lesion-specific or myocardial inducible ischemia; this modifier does not replace the anatomic CAD-RADS category.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 section 3.3.5 and Tables 6-7 (ischemia modifier I+)

I-

15 de 19

Modifier I-, negative ischemia

Negative lesion-specific ischemia: CT-FFR >0.80, or myocardial CT perfusion with no inducible ischemia. A fixed prior infarct is documented in the impression rather than treated as inducible ischemia.

CondutaWhen concordant with the anatomy and clinical context, I- may support deferral of invasive coronary angiography; it does not remove the need for preventive management indicated by plaque or stenosis.

RiscoNo imaging evidence of inducible ischemia on the performed CT-based functional test; this is not equivalent to absence of coronary atherosclerotic risk.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 section 3.3.5 and Tables 6-7 (ischemia modifier I-)

I+/-

16 de 19

Modifier I+/-, borderline or indeterminate ischemia

Borderline or indeterminate ischemia: lesion-specific CT-FFR 0.76-0.80, or myocardial CT perfusion that is borderline or inconclusive for inducible ischemia.

CondutaDo not convert I+/- into a binary decision. Further decisions depend on lesion location, symptom severity, anatomy and, for CT-FFR, the trans-lesional gradient; CAD-RADS 2.0 notes a delta CT-FFR >0.12 as significant context.

RiscoIndeterminate functional significance; residual uncertainty must be stated explicitly.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 section 3.3.5 and Tables 6-7 (ischemia modifier I+/-)

17 de 19

Modifier S, coronary stent present

Add S when at least one coronary stent is present anywhere in the coronary system. Grade in-stent stenosis using the same stenosis bands as native coronary arteries.

CondutaS is a structural modifier, not a standalone management category; management follows the stenosis category, plaque burden, symptoms and clinical context.

RiscoPresence of a coronary stent; S alone is not a disease-severity or event-risk grade.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 section 3.3.2 (Modifier S) and Figure 13

18 de 19

Modifier G, coronary bypass graft present

Add G when at least one coronary bypass graft is present. Do not count a native stenosis proximal to a fully patent graft for CAD-RADS coding; assess grafts and native segments distal to and including the anastomosis. Assess plaque burden across native arteries and grafts together.

CondutaG is a structural modifier. Further management depends on stenosis or occlusion in the evaluated grafts and eligible native segments, plus symptoms and clinical context.

RiscoPresence of coronary bypass grafting; G alone is not a disease-severity or event-risk grade.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 section 3.3.3 (Modifier G) and Figure 14

19 de 19

Modifier E, non-atherosclerotic exception

Add E at the end of the CAD-RADS code for a non-atherosclerotic coronary abnormality or narrowing, including dissection, anomalous origin, aneurysm or pseudoaneurysm, vasculitis, fistula, extrinsic compression, arteriovenous malformation or another exception. The numeric category alone may not capture the abnormality.

CondutaUse disease-specific management considerations and/or subspecialty referral; do not treat the atherosclerotic CAD-RADS category as a complete management description for an E case.

RiscoNon-atherosclerotic coronary pathology whose risk is not represented by the atherosclerotic stenosis category alone.

verificadoCAD-RADS 2.0: Coronary Artery Disease Reporting and Data SystemCAD-RADS 2.0 Table 3 and section 3.3.6 (Modifier E)

Lógica de decisão estruturada

Compose stenosis, plaque burden, then modifiers. N may replace the numeric stenosis category or follow it depending on diagnostic segments; use the cited outcome criteria rather than inferring a code.

{
  "categories": [
    "0",
    "1",
    "2",
    "3",
    "4A",
    "4B",
    "5"
  ],
  "components": {
    "stenosis": {
      "basis": "most_severe_luminal_stenosis_per_patient",
      "codes": [
        "0",
        "1",
        "2",
        "3",
        "4A",
        "4B",
        "5"
      ]
    },
    "plaque_burden": {
      "code_prefix": "P",
      "codes": [
        "P1",
        "P2",
        "P3",
        "P4"
      ],
      "assessment_methods": [
        "CAC",
        "SIS",
        "visual"
      ],
      "omit_with": [
        "0"
      ]
    },
    "modifiers": {
      "non_diagnostic": [
        "N"
      ],
      "high_risk_plaque": [
        "HRP"
      ],
      "ischemia": [
        "I+",
        "I-",
        "I+/-"
      ],
      "stent": [
        "S"
      ],
      "graft": [
        "G"
      ],
      "exception": [
        "E"
      ]
    }
  },
  "separator": "/",
  "modifier_order": [
    "N",
    "HRP",
    "I",
    "S",
    "G",
    "E"
  ]
}

Referência, não é dispositivo médico. Confira a publicação primária vigente. O radiologista que assina o laudo continua autor e responsável.