RadEssentialReading-room reference
CAD-RADS 2.0
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Report the highest-grade stenosis in any vessel over 1.5 mm, then plaque burden, then modifiers, e.g. CAD-RADS 3/P2/HRP/I+. Version 2.0 added plaque burden (P1–P4) and ischemia (I), and replaced the old V modifier with HRP.
Stenosis category
| Category | Stenosis | Stable chest pain: next step |
|---|---|---|
| 0 | 0%, no plaque | No further cardiac testing |
| 1 | 1–24%, or plaque with positive remodeling but no stenosis | Preventive therapy |
| 2 | 25–49% | Preventive therapy |
| 3 | 50–69% | Consider functional testing |
| 4A | 70–99% in 1 or 2 vessels | ICA or functional assessment |
| 4B | Left main ≥50%, or 3-vessel ≥70% | Invasive angiography |
| 5 | 100% (total occlusion) | ICA and/or viability |
| N | Non-diagnostic study | Additional evaluation |
Plaque burden
| Grade | Descriptor | CAC score | Segment involvement score |
|---|---|---|---|
| P1 | Mild | 1–100 | 1–2 |
| P2 | Moderate | 101–300 | 3–4 |
| P3 | Severe | 301–999 | 5–7 |
| P4 | Extensive | ≥1000 | ≥8 |
Modifiers
| Modifier | Meaning |
|---|---|
| N | One or more non-diagnostic segments; if a diagnostic segment shows ≥50%, report 3/N rather than N alone |
| HRP | High-risk plaque: 2 or more of low attenuation (<30 HU), positive remodeling, spotty calcification, napkin-ring sign |
| I+ / I− / I± | Ischemia from CT-FFR or stress CT perfusion: present, absent, or indeterminate |
| S | Stent present |
| G | Bypass graft present; bypassed native stenoses are not graded |
| E | Exception: non-atherosclerotic cause such as anomalous origin, dissection, aneurysm, vasculitis, fistula or extrinsic compression |
Acute chest pain uses different management recommendations, e.g. CAD-RADS 3 warrants functional testing or admission depending on troponin and HRP. Check the consensus tables before applying in the emergency setting.
Sources
- Cury RC, Leipsic J, Abbara S, et al. CAD-RADS™ 2.0 – 2022 Coronary Artery Disease-Reporting and Data System: an expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr. 2022;16:536–557.PubMed ↗
Radessential summarizes published classification systems for practicing radiologists. Summaries are condensed; confirm details against the cited source before relying on them for patient care.