VIDEO: What is new with CAD-RADS 2.0 cardiac imaging reporting?
Ricardo Cury, MD, MBA, MSCCT, chairman of radiology, direct of cardiac imaging, Baptist Health South Florida and Miami Cardiac and Vascular Institute, discusses the new CAD-RADS 2.0 cardiac imaging reporting criteria. He spoke with Radiology Business at the 2022 Society of Cardiovascular Computed Tomography (SCCT) meeting.
The first version of the Coronary Artery Disease Radiology (CAD-RADS) Reporting and Management System was released in 2016 in attempt to standardize the terminology used in radiology and cardiac imaging reports. Like LUNG-RADS, BI-RADS and other radiology standardized reporting guidelines, CAD-RADS was designed to reduce variations between different radiologists reading these exams and make the reports more reproducible between readers to enable better correlation with prior imaging reports.
Part of the reason for the updated document was based on an expected increase in use of cardiac CT angiography (CCTA), according to the 2021 American Heart Association (AHA) and American College of Cardiology (ACC) chest pain evaluation guidelines, released last fall. The guidelines elevated CCTA to a front-line chest pain imaging guideline. The new CAD-RADS helps codify next steps in the patient's care based on what is found in their imaging.
"Finally, coronary CTA now has a Level 1A indication, the highest level of evidence for the evaluation of symptomatic patients with both stable CAD and acute chest pain in the ER," Cury explained. "This is really a major milestone for cardiac CT. And CAD-RADS 2.0 is trying to standardize the reporting so that we can link the CT information with clinical recommendations. In addition to the images, you really need clear and concise reporting that will impact the next step in the patient recommendations."
The 2016 CAD-RADS outlines reporting of the level of coronary disease, from minimal, mild, moderate, severe and total occlusion.
The 2022 update includes additional reporting components, including more information on the level of plaque and modifiers that could impact patient assessments and risk.
Overall plaque burden assessment is graded P1-P4, starting with mild amounts of plaque up to extensive amounts of plaque, Cury said. He said the P1-P4 scores also can correlate with calcium score, and visual assessment of the number of disease vessel segments involved.
Two new modifiers were also added to CAD-RADS, including extra information provided by FFR-CT or CT perfusion. FFR-CT was included in this new version of CAD-RADS because it was included in the 2021 AHA/ACC chest pain evaluation guidelines.
The second modifier section added were modifier E exceptions. These include the presence of coronary dissection, anomalous origin of the coronary artery, vasculitis, coronary fistula, coronary aneurysm, coronary artery compression, and arterio-venous malformations.
CAD-RADS had previously included a modifier for vulnerable plaques (VP), which was changed in 2.0 to the designation "high risk plaques," or HRP. These are defined as stenoses with spotty calcium, napkin ring sign, positive remodeling, and presence of low attenuation plaques.
"There will be some impact in the patient's clinical pathway if they have one of these high-risk features," Cury explained.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com