Abstract
BackgroundThe 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 resultsA 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. Eighty-seven percentage of referring consultants considered CAD-RADS reporting system to be “quite helpful” or “completely helpful” for clinical decision-making in CAD.ConclusionCAD-RADS is valuable for improving CCTA structural reports and facilitating decision-making with high diagnostic accuracy and high reproducibility.
Highlights
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)
CAD-RADS is valuable for improving CCTA structural reports and facilitating decision-making with high diagnostic accuracy and high reproducibility
Referring consultants considered CAD-RADS a helpful classification for clinical decision-making in CAD
Summary
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). Coronary computed tomography angiography (CCTA) has emerged as a powerful modality to exclude obstructive coronary artery stenosis in the diagnostic workup of patients with suspected CAD [3]. The structured reporting system for CCTA was introduced in 2016 by Curye et al and is called the “coronary artery disease reporting and data system” (CAD-RADS) [6]. It is the first attempt to provide a simple, concise, and accurate classification of CAD This new classification is expected to improve the communication and facilitate understanding of the CCTA report with the added inputs of further investigations and management recommendations. The clinical impact on patient prognosis has not been extensively studied [8]
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