Coronary Artery Disease Reporting CAD-RADS 2.0

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Questions and Answers

What does the modifier 'HRP' stand for in the updated CAD-RADS version?

Heart-related patient

High-risk plaque (correct)

Human risk profile

Harmful risk partition

Which modifier indicates that a study is non-diagnostic?

N (correct)

HRP

What is a primary reason why various quantitative approaches for assessing total coronary plaque are not routinely performed?

They provide too much information.

They are not effective.

They are too costly.

They are time and labor intensive. (correct)

Which of the following is a newly added modifier in the CAD-RADS framework?

E for exceptions Signup and view all the answers

What aspect of patient assessment does the CAD-RADS framework aim to validate further?

Reproducibility of different approaches Signup and view all the answers

How are CAD-RADS categories enhanced to indicate the presence of significant lesions or plaques?

By incorporating additional modifiers Signup and view all the answers

Which quantitative assessment technique needs further validation against other methods like intravascular ultrasound?

Total coronary plaque assessment Signup and view all the answers

What is a potential outcome of incorporating novel techniques for plaque quantification into CAD-RADS?

Improving risk assessments Signup and view all the answers

What is indicated by modifier 'S' in the CAD-RADS classification?

Presence of coronary stents Signup and view all the answers

In which CAD-RADS category would a patient with a 60% stenosis in the left anterior descending artery (LAD) and non-obstructive disease in other vessels be classified?

CAD-RADS 5/P3/G Signup and view all the answers

What classification is assigned to a patient with significant in-stent restenosis in the proximal LAD?

CAD-RADS 4A/S Signup and view all the answers

Which feature is NOT associated with high-risk plaque characteristics?

Extensive calcification Signup and view all the answers

If a stent is found to be non-evaluable with no other stenosis greater than 50%, how is the study classified?

CAD-RADS N/S Signup and view all the answers

What is the classification for a non-stenotic stent in the LAD and a new severe stenosis in the RCA?

CAD-RADS 4A/S Signup and view all the answers

Which of the following is considered a characteristic of high-risk plaque?

Napkin-ring sign Signup and view all the answers

How should total plaque burden be assessed in relation to CAD-RADS classification?

In both native arteries and bypass grafts Signup and view all the answers

What does a higher score in the CAD-RADS assessment indicate?

Higher rates of cardiovascular death or myocardial infarction Signup and view all the answers

Which method is primarily used for visual estimation of overall plaque burden?

Qualitative assessment of calcified and non-calcified plaque Signup and view all the answers

What is the highest possible score in the coronary segment assessment for detectable plaque?

16 Signup and view all the answers

What information does the CAD-RADS assessment primarily rely on for patient management?

Expert opinion on plaque assessment Signup and view all the answers

What does the CAD-RADS assessment aim to facilitate in routine evaluations?

Flexible options to estimate overall plaque amounts Signup and view all the answers

In the context of CAD-RADS, what is the significance of identifying high-risk plaque?

It correlates with higher mortality and cardiovascular events Signup and view all the answers

Which feature characterizes the assessment of stenosis according to CAD-RADS guidelines?

Stenosis severity is categorized by percentage narrowing Signup and view all the answers

Which type of abnormalities are not focused on within the CAD-RADS framework?

Non-atherosclerotic abnormalities Signup and view all the answers

Study Notes

Coronary Artery Disease Reporting and Data System (CAD-RADS) 2.0

CAD-RADS 2.0 is an updated system for standardized reporting of coronary CT angiography (CCTA)
Aims to improve initial reporting by incorporating new technical advances, clinical trials, and guidelines
Maintains a framework of stenosis, plaque burden, and modifiers
Includes assessment of lesion-specific ischemia using CT fractional-flow reserve (CT-FFR) or myocardial CT perfusion (CTP), if performed
Stenosis severity is determined by the most severe luminal narrowing per patient
Ranges from CAD-RADS 0 (no plaque/stenosis) to CAD-RADS 5 (at least one totally occluded coronary artery)
Emphasizes methods for estimating and reporting total plaque burden (P1-P4 descriptors)
Main goal is standardized reporting and communication with referring physicians for improved patient management
CAD-RADS is not a substitute for physician impression
Clinical value of CAD-RADS for predicting major adverse cardiac events is validated in numerous publications. Outperforms traditional risk factors.

Clinical Value and Clinical Application of CCTA

CCTA is now a first-line test for acute and chronic coronary syndromes, based on expert consensus and clinical trial evidence
CCTA helps manage patients with suspected stable coronary artery disease. This is supported by the PROMISE and SCOT-HEART trials
CCTA has a favorable effect in reducing downstream testing and cardiology referrals for patients with non-obstructive coronary artery disease
Enhanced medical therapy and blood pressure control are observed
Negative CCTA results can support safe discharge in low-to-intermediate risk acute chest pain patients in the emergency department, supported by several prospective clinical trials (CT-STAT, ACRIN-PA, ROMICAT II, CT-COMPARE)

CAD-RADS Reporting System

Reports use a standardized grading system for stenosis severity (see Table 1)
Plaques are classified into P1 (mild), P2 (moderate), P3 (severe), and P4 (extensive) categories (see Table 2)
Reports may include Modifiers like ischemia (I), exceptions (E), and other conditions
Table 4 details CAD-RADS for stable chest pain, including indications for further investigation.
Table 5 details CAD-RADS for acute chest pain, indicating recommendations for investigation and management based on risk.
CAD-RADS 0-5 categories describe various levels of severity of disease
Consideration of high-risk plaques which includes spotty calcifications and positive remodeling
Additional reporting may be required for conditions like Coronary dissection, Anomalous origin of the coronary arteries, Coronary artery aneurysm, Vasculitis, Coronary artery fistula, Extrinsic coronary artery compression

CAD-RADS Reporting Examples

Figures 2-6 provide examples of different plaque burden amounts and associated categories.
Figures 7-12 illustrate CAD-RADS categories 4A, 4B, 5, and N (not diagnosable)
Figures 13-17 provide examples of specific plaque features (e.g. location, amount, high-risk features).

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Description

Explore the updated CAD-RADS 2.0 system designed for standardized reporting of coronary CT angiography (CCTA). This quiz covers key aspects such as stenosis severity, plaque burden, and lesion-specific ischemia assessment, providing insights into improved patient management. Test your understanding of this critical framework in cardiovascular diagnostics.