6月15日，美国心血管CT学会（SCCT）、美国放射学会（ACR）和北美心血管影像学会（NASCI），共同发布了一份新的冠状动脉CT血管造影（CTA）报告规范——冠状动脉疾病报告与数据系统（CAD-RADS），其主要目标是规范报告冠状动脉CTA检查结果、便于检查结果的交流及医生对患者作进一步处理。
CAD-RADS分类取决于狭窄程度。SCCT建议分类系统为狭窄严重程度分级（表1）。表2和表3分别列出稳定性胸痛和急性胸痛的CAD-RADS报告制度分类。
CAD-RADS规定了0（无狭窄）~5（至少一条动脉完全闭塞）的范围，根据分类进行进一步成像或处理。修饰符S（支架）、G（移植）和V（易损斑块）用来更好地描述动脉。
Fig.1.CAD-RADS0.Normalleftmain,LAD,LCXandRCAwithoutplaqueorstenosis.
Fig.2.
CAD-RADS1.MinimalcalcifiedplaqueintheproximalLADwithminimalluminalnarrowing(lessthan25%diameterstenosis).
Fig.3.
CAD-RADS2.PredominantlycalcifiedplaqueintheproximalLADwith25-49%diameterstenosis(left).Invasivecoronaryangiographyconfirming25-49%stenosis(right).
Fig.4.
CAD-RADS3.PredominantlycalcifiedplaqueinthemidLCXwith50-69%diameterstenosis.Leftimage:CoronaryCTA.Rightimage:Invasivecoronaryangiography.
Fig.5.
CAD-RADS4A.Focalnon-calcifiedplaqueinthemidLAD(yellowarrow)with70-99%diameterstenosis(left).Invasivecoronaryangiographyconfirming70-99%stenosisinthemidLAD(yellowarrow,right).(Forinterpretationofthereferencestocolourinthisfigurelegend,thereaderisreferredtothewebversionofthisarticle.)
Fig.6.
CAD-RADS4B.Three-vesselobstructivedisease(70%stenosis),includingin70-99%stenosisoftheproximalRCA(left),70-99%stenosisoftheproximalLAD(middle)andin70-99%stenosisofthemidLCX(right).
Fig.7.
CAD-RADS4B.Distalleftmainstenosiswithcircumferentialcalcifiedplaqueresultingin50%stenosis(arrow).Upperleftpanel:obliquelongitudinalplaneoftheleftmaincoronaryartery.Lowerleftpanelecross-sectionalsliceofthedistalleftmaincoronaryartery.Figuresontheright-Invasivecoronaryangiographyconfirmingfocalseverestenosisinthedistalleftmaincoronaryartery.
Fig.8.
CAD-RADS5.TwoexamplesofcasescodedasCAD-RADS5.Left:Focal,non-calcifiedocclusionoftheproximalRCA(arrow).Right:TotalocclusionoftheproximalLCX(arrow).Asmallfocusof“orphan”calciumalongthedistalLCXsupportsthediagnosisofchronictotalocclusion.
Fig.9.
CAD-RADSN.Motionartifactsobscuringtheleftmain,LADandLCXarteries,whichrendersthesesegmentsnon-diagnostic(left).MotionartifactsinthemidRCA(right).
Fig.10.
CAD-RADS3/N.MotionartifactobscuringthemidRCA(left,arrow),whichrendersthissegmentnon-diagnostic.ThereisalsostenosisofthemidLADwith50-69%luminalnarrowing(right,arrow),qualifyingthislesionasCADRADS3.AlthoughthemidRCAsegmentisnon-diagnostic,thepresenceofsuspectedobstructivediseasewithintheLADshouldbecodedasCADRADS3/N.IftheLADlesionweremild(lessthan50%diameterstenosis),andnootherplaqueswereidentified,thepatientwouldbecodedasCADRADSN.
Fig.11.
CAD-RADS4A/S.In-stentstenosisoftheproximalLADwithsignificantluminalnarrowing(70-99%stenosis).Gradingofin-stentstenosisshouldfollowthegradingofnormalcoronaryarteries(0%stenosis,1-24%stenosis,25-49%stenosis,50-69%stenosis,70-99%stenosis,and99%stenosis).Inthiscase,severein-stentrestenosisdesignatesaCAD-RADS4Alesion,whichwouldbefollowedbythestentmodifier“S.”
Fig.12.
CAD-RADS2/V.Focalnon-calcifiedplaqueinthemidRCAwith25-49%diameterstenosis.Theplaquedemonstratestwohighriskfeatures,lowattenuation(30HU)andpositiveremodeling,thuscodingwiththemodifier“V.”
Fig.13.
CAD-RADS3/S/V.ExampledemonstratingapatentstentintheproximalRCA(0%stenosis)withhigh-riskplaqueintheproximalLADresultingin50-69%stenosis.Inisolation,theproximalLADlesionwouldbecodedCADRADS3/V.However,sinceCADRADSiscodedonaper-patientbasis,andaRCAstentispresent,thispatientwouldbecodedasCADRADS3/S/V.
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