The validity and applicability of CAD-RADS in the management of patients with coronary artery disease

Abstract

Background: The coronary artery disease reporting and data system (CAD-RADS) is designed for a uniform standardization of coronary computed tomography angiography (CCTA) reporting and further management recommendations of coronary artery disease (CAD). This study aimed to assess clinical validity, applicability, and reproducibility of CAD-RADS in the management of patients with CAD. Methods and results:A single-center prospective study included 287 patients with clinically suspected or operated CAD who underwent CCTA. Four reviewers evaluated the CCTA images independently and assigned a CAD-RADS category to each patient. The invasive coronary angiography (ICA) was used as the reference standard for calculating diagnostic performance of CAD-RADS for categorizing the degree of coronary artery stenosis. The intra-class correlation (ICC) was used to test the inter-reviewer agreement (IRA). Reporting was provided to referring consultants according to the CAD-RADS. Based on ICA results, we have 156 patients with non-significant CAD and 131 patients with significant CAD. On a patient-based analysis, regarding those patients classified as CAD-RADS 4 and CAD-RADS 5 for predicting significant CAD, the CAD-RADS had a sensitivity, specificity, and an accuracy of 100%, 96.8 to 98.7%, and 98.3 to 99.3%, respectively, depending on the reviewer. There was an excellent IRA for CAD-RADS categories (ICC = 0.9862). The best cutoff value for predicting significant CAD was > CAD-RADS 3. Eightyseven percentage of referring consultants considered CAD-RADS reporting system to be "quite helpful" or "completely helpful" for clinical decision-making in CAD.Conclusion: CAD-RADS is valuable for improving CCTA structural reports and facilitating decision-making with high diagnostic accuracy and high reproducibility.

Coronary CT Angiography CAD-RADS versus Coronary Artery Calcium Score in Patients with Acute Chest Pain

“…Since CAD-RADS was introduced, many studies have demonstrated the prognostic value for MACEs and the diagnostic performance of CAD-RADS for predicting CAD (12,20). A recent study in Prospective Multicenter Imaging Study for Evaluation of Chest Pain (12) demonstrated that CCTA findings associated with future MACEs include traditional stenosis categories of the coronary artery, vulnerable plaque, and higher CAD-RADS category.…”

Imaging of the aortic root on high-pitch non-gated and ECG-gated CT: awareness is the key!

“…CTA is the most commonly used modality for aortic evaluation. The accuracy and hence use of CTA for other vascular applications like coronary artery imaging is also expanding [11]. CT is fast, noninvasive, widely available, and allows evaluation of entire aorta with very high (nearly 100%) sensitivity and specificity for the diagnosis of aortic pathologies [2,4,12].…”

Validation of Coronary Artery Disease Reporting and Data System (CAD-RADS) and Application of Coronary Artery Calcium Data and Reporting System (CAC-DRS) as New Standardized Tools in the Management of Coronary Artery Disease Patients

“…As a result, we recommend conducting more studies to confirm or contradict our cut-off value as recommended before in prior research. 21 …”

“…As a result, we recommend conducting more studies to confirm or contradict our cutoff value as recommended before in prior research. 21 CACS can be assessed at a low radiation dosage, which would be less harmful to low-risk individuals. If the CACS is 0, CCTA may not be necessary, 22 which agrees with Bittner et al 23 They reported no cases of obstructive CAD assigned as CAC-DRS 0.…”