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CAD-RADS 2.0 (Coronary CTA)

CAD-RADS 2.0 (2022)

Standardized coronary CTA reporting: assigns a stenosis category (0, 1, 2, 3, 4A, 4B, 5, or N), an overall plaque-burden grade (P1–P4), and modifiers (N, HRP, I, S, G, E), then pairs the composite code with management suggestions for stable or acute chest pain.

Also searched as: stenosis · plaque · ffr-ct · ctp · cardiac · heart

Clinical presentation
Maximal stenosis (any vessel ≥1.5 mm)
Extent of severe disease (if maximal stenosis ≥50%)

Determines CAD-RADS 4B: left main ≥50% qualifies whenever maximal stenosis is at least 50%, three-vessel disease only when obstructive (≥70%).

Non-evaluable vessel(s): obstructive CAD cannot be excluded

If maximal stenosis is <50% and any segment is non-diagnostic, the exam is coded CAD-RADS N.

Atherosclerotic plaque present
Overall plaque burden
High-risk plaque (HRP) features

Two or more of: spotty calcification, low-attenuation plaque (<30 HU), positive remodeling, napkin-ring sign.

Coronary stent present (modifier S)
Bypass graft present (modifier G)
Non-atherosclerotic coronary abnormality (modifier E)

E.g., dissection, anomalous origin, aneurysm/pseudoaneurysm, vasculitis, fistula, extrinsic compression, AV malformation.

CT-based ischemia test available
CT-FFR result
CTP result
Information
Incomplete input
  • Please provide: clinical presentation (acute vs stable chest pain), maximal stenosis degree.

How this tool works

CAD-RADS 2.0 (2022) grades the single most severe coronary stenosis in any vessel of at least 1.5 mm diameter. Severe stenosis (70–99%) is subdivided: 4A for one- or two-vessel disease and 4B for left main stenosis of 50% or more or obstructive three-vessel disease. When non-evaluable segments prevent exclusion of obstructive disease, the examination is coded N instead of a number below category 3, or the modifier N is appended at category 3 and above. Plaque burden P1–P4 follows the stenosis category, and modifiers are appended in the fixed order N, HRP, I, S, G, E. The ischemia modifier derives from CT-FFR (abnormal ≤0.75, borderline 0.76–0.80, normal >0.80) or stress CT perfusion (reversible or peri-infarct ischemia = I+). Recommendations differ between stable and acute presentations.

References

Implemented from the cited published sources. Educational use only; confirm against current guidelines before clinical use.

Clinical questions that use this

Vetting guides that reach for this tool.

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