Podcast
Questions and Answers
What does the modifier 'HRP' stand for in the updated CAD-RADS version?
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?
Which modifier indicates that a study is non-diagnostic?
- G
- S
- N (correct)
- HRP
What is a primary reason why various quantitative approaches for assessing total coronary plaque are not routinely performed?
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?
Which of the following is a newly added modifier in the CAD-RADS framework?
What aspect of patient assessment does the CAD-RADS framework aim to validate further?
What aspect of patient assessment does the CAD-RADS framework aim to validate further?
How are CAD-RADS categories enhanced to indicate the presence of significant lesions or plaques?
How are CAD-RADS categories enhanced to indicate the presence of significant lesions or plaques?
Which quantitative assessment technique needs further validation against other methods like intravascular ultrasound?
Which quantitative assessment technique needs further validation against other methods like intravascular ultrasound?
What is a potential outcome of incorporating novel techniques for plaque quantification into CAD-RADS?
What is a potential outcome of incorporating novel techniques for plaque quantification into CAD-RADS?
What is indicated by modifier 'S' in the CAD-RADS classification?
What is indicated by modifier 'S' in the CAD-RADS classification?
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?
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?
What classification is assigned to a patient with significant in-stent restenosis in the proximal LAD?
What classification is assigned to a patient with significant in-stent restenosis in the proximal LAD?
Which feature is NOT associated with high-risk plaque characteristics?
Which feature is NOT associated with high-risk plaque characteristics?
If a stent is found to be non-evaluable with no other stenosis greater than 50%, how is the study classified?
If a stent is found to be non-evaluable with no other stenosis greater than 50%, how is the study classified?
What is the classification for a non-stenotic stent in the LAD and a new severe stenosis in the RCA?
What is the classification for a non-stenotic stent in the LAD and a new severe stenosis in the RCA?
Which of the following is considered a characteristic of high-risk plaque?
Which of the following is considered a characteristic of high-risk plaque?
How should total plaque burden be assessed in relation to CAD-RADS classification?
How should total plaque burden be assessed in relation to CAD-RADS classification?
What does a higher score in the CAD-RADS assessment indicate?
What does a higher score in the CAD-RADS assessment indicate?
Which method is primarily used for visual estimation of overall plaque burden?
Which method is primarily used for visual estimation of overall plaque burden?
What is the highest possible score in the coronary segment assessment for detectable plaque?
What is the highest possible score in the coronary segment assessment for detectable plaque?
What information does the CAD-RADS assessment primarily rely on for patient management?
What information does the CAD-RADS assessment primarily rely on for patient management?
What does the CAD-RADS assessment aim to facilitate in routine evaluations?
What does the CAD-RADS assessment aim to facilitate in routine evaluations?
In the context of CAD-RADS, what is the significance of identifying high-risk plaque?
In the context of CAD-RADS, what is the significance of identifying high-risk plaque?
Which feature characterizes the assessment of stenosis according to CAD-RADS guidelines?
Which feature characterizes the assessment of stenosis according to CAD-RADS guidelines?
Which type of abnormalities are not focused on within the CAD-RADS framework?
Which type of abnormalities are not focused on within the CAD-RADS framework?
Flashcards
CAD-RADS
CAD-RADS
A method for assessing the extent of coronary plaque in coronary computed tomography angiography (CCTA).
Coronary Plaque
Coronary Plaque
Buildup of material (fat, cholesterol, calcium, etc.) on the inner walls of the coronary arteries.
Visual Estimate of Plaque Burden
Visual Estimate of Plaque Burden
Method to assess the amount of calcified and non-calcified plaque in coronary vessels.
Coronary Computed Tomography Angiography (CCTA)
Coronary Computed Tomography Angiography (CCTA)
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Plaque Burden
Plaque Burden
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Segment Assessment
Segment Assessment
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Invasive Coronary Angiography
Invasive Coronary Angiography
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SIS
SIS
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CAD-RADS Categories
CAD-RADS Categories
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Quantitative Plaque Assessment
Quantitative Plaque Assessment
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Thresholds for Therapy
Thresholds for Therapy
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CAD-RADS Modifiers
CAD-RADS Modifiers
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Modifier N - Non-Diagnostic Study
Modifier N - Non-Diagnostic Study
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Modifier HRP - High-Risk Plaque
Modifier HRP - High-Risk Plaque
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Modifier I - Ischemia
Modifier I - Ischemia
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Modifier E - Exceptions
Modifier E - Exceptions
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CAD-RADS Modifier 'S'
CAD-RADS Modifier 'S'
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CAD-RADS Modifier 'N'
CAD-RADS Modifier 'N'
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High-Risk Plaque (HRP)
High-Risk Plaque (HRP)
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Positive Remodeling
Positive Remodeling
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Low-Attenuation Plaque
Low-Attenuation Plaque
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Spotty Calcification
Spotty Calcification
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Napkin-Ring Sign
Napkin-Ring Sign
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Thin Cap Fibroatheroma
Thin Cap Fibroatheroma
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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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