CAD-RADS · Cardíaco

CAD-RADS Coronary Artery Disease Reporting and Data System v2.0

vigente

Standardized reporting of coronary CT angiography by maximal stenosis, plaque burden, ischemia and modifiers.

Índice de referência, não é suporte à decisão clínica. O RadCommons apresenta conteúdo de referência reescrito a partir de critérios publicados e com link para a fonte primária. Confira sempre a publicação primária vigente. Não é um dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

Escala de categorias

0 1 2 3 4A 4B 5 P1 P2 P3 P4 N HRP I+I-I+/-S G E

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Procedência e vigência

Órgão emissor: SCCT / ACC / ACR / NASCI
Versão: 2.0
Ano: 2022
Família: léxico
Tipo de lógica: flat
Modalidade: CT
Fonte primária: CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System · doi:10.1016/j.jcct.2022.07.002
Última verificação: 2026-07-24
Última checagem: 2026-07-24

Lógica de decisão

Forma estruturada (flat). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

Compose stenosis, plaque burden, then modifiers. N may replace the numeric stenosis category or follow it depending on diagnostic segments; use the cited outcome criteria rather than inferring a code.

Mostrar a lógica estruturada (JSON)

{
  "categories": [
    "0",
    "1",
    "2",
    "3",
    "4A",
    "4B",
    "5"
  ],
  "components": {
    "stenosis": {
      "basis": "most_severe_luminal_stenosis_per_patient",
      "codes": [
        "0",
        "1",
        "2",
        "3",
        "4A",
        "4B",
        "5"
      ]
    },
    "plaque_burden": {
      "code_prefix": "P",
      "codes": [
        "P1",
        "P2",
        "P3",
        "P4"
      ],
      "assessment_methods": [
        "CAC",
        "SIS",
        "visual"
      ],
      "omit_with": [
        "0"
      ]
    },
    "modifiers": {
      "non_diagnostic": [
        "N"
      ],
      "high_risk_plaque": [
        "HRP"
      ],
      "ischemia": [
        "I+",
        "I-",
        "I+/-"
      ],
      "stent": [
        "S"
      ],
      "graft": [
        "G"
      ],
      "exception": [
        "E"
      ]
    }
  },
  "separator": "/",
  "modifier_order": [
    "N",
    "HRP",
    "I",
    "S",
    "G",
    "E"
  ]
}

Categorias num relance

Cat.	Significado	Conduta	Risco	Fonte
0	0 percent, no plaque 0% maximal coronary stenosis - no plaque and no luminal stenosis (absence of coronary atherosclerosis).	Reassurance; consideration of non-atherosclerotic causes of symptoms; preventive measures / risk-factor management as clinically appropriate.	No coronary atherosclerosis.	okfonte CAD-RADS 2.0 stenosis categories table (CAD-RADS 0 row), per-patient maximal stenosis
1	1 to 24 percent, minimal 1-24% maximal coronary stenosis - minimal stenosis or plaque with no stenosis.	Emphasis on preventive therapy and risk-factor modification; generally no further cardiac testing for the stenosis itself.	Minimal coronary stenosis.	okfonte CAD-RADS 2.0 stenosis categories table (CAD-RADS 1 row)
2	25 to 49 percent, mild 25-49% maximal coronary stenosis - mild stenosis.	Preventive therapy and risk-factor modification; considered non-obstructive, so no specific ischemia work-up is mandated for the stenosis alone.	Mild, non-obstructive coronary stenosis.	okfonte CAD-RADS 2.0 stenosis categories table (CAD-RADS 2 row)
3	50 to 69 percent, moderate 50-69% maximal coronary stenosis - moderate stenosis.	Consideration of functional/ischemia assessment (e.g. CT-FFR, myocardial CT perfusion, stress testing) or invasive coronary angiography (ICA) when ischemia evaluation is needed; preventive therapy.	Moderate stenosis, potentially obstructive.	okfonte CAD-RADS 2.0 stenosis categories table (CAD-RADS 3 row)
4A	70 to 99 percent in 1 or 2 vessels, severe 70-99% maximal coronary stenosis (severe) in 1 or 2 vessels, without left main involvement or 3-vessel obstructive disease.	Consideration of ICA and/or functional imaging (e.g. CT-FFR, myocardial CT perfusion, stress testing); preventive therapy and risk-factor modification.	Severe, obstructive stenosis limited to 1 or 2 vessels.	okfonte CAD-RADS 2.0 stenosis categories table (CAD-RADS 4A row), per-patient maximal stenosis
4B	Left main 50 percent or more, or 3-vessel obstructive disease Left main stenosis >=50% OR 3-vessel obstructive disease (>=70% stenosis in each of three vessels).	ICA recommended, with possible revascularization, particularly in symptomatic patients; this higher-risk anatomy is managed more aggressively than 4A.	Severe stenosis with higher-risk anatomy (left main or 3-vessel obstructive disease).	okfonte CAD-RADS 2.0 stenosis categories table (CAD-RADS 4B row), per-patient maximal stenosis
5	100 percent, total occlusion 100% stenosis - total coronary occlusion of at least one coronary artery (i.e. >99% / complete occlusion).	Consideration of ICA and/or viability assessment; evaluate whether the occlusion is acute versus chronic and assess collateralization, guiding possible revascularization.	Total coronary occlusion.	okfonte CAD-RADS 2.0 stenosis categories table (CAD-RADS 5 row)
P1	Plaque burden P1, mild Mild overall coronary plaque burden on a per-patient basis: CAC 1-100; SIS <=2; or visual estimation of a mild amount of plaque in 1-2 vessels. CAD-RADS 0 denotes no plaque, so P0 is not used.	Report P1 after the stenosis category and interpret it with the full impression and clinical context. CAD-RADS 2.0 does not define an absolute treatment threshold from the P category alone.	Mild total coronary plaque burden; plaque burden contributes prognostic information beyond stenosis severity alone.	okfonte CAD-RADS 2.0 section 3.2.1 and Table 2 (P1 row); Tables 4-5 for management context
P2	Plaque burden P2, moderate Moderate overall coronary plaque burden on a per-patient basis: CAC 101-300; SIS 3-4; or visual estimation of a moderate amount of plaque in 1-2 vessels or a mild amount in 3 vessels.	Report P2 after the stenosis category. A higher plaque burden may support more intensive preventive therapy consideration, but CAD-RADS 2.0 states that P categories are not absolute treatment thresholds and should be integrated with the impression and clinical context.	Moderate total coronary plaque burden; increasing plaque burden is associated with increasing cardiovascular risk independently of stenosis severity.	okfonte CAD-RADS 2.0 section 3.2.1 and Table 2 (P2 row); Tables 4-5 for management context
P3	Plaque burden P3, severe Severe overall coronary plaque burden on a per-patient basis: CAC 301-999; SIS 5-7; or visual estimation of a moderate amount of plaque in 3 vessels or a severe amount in 1 vessel.	Report P3 after the stenosis category. A higher plaque burden may support more intensive preventive therapy consideration, but CAD-RADS 2.0 states that P categories are not absolute treatment thresholds and should be integrated with the impression and clinical context.	Severe total coronary plaque burden; increasing plaque burden is associated with increasing cardiovascular risk independently of stenosis severity.	okfonte CAD-RADS 2.0 section 3.2.1 and Table 2 (P3 row); Tables 4-5 for management context
P4	Plaque burden P4, extensive Extensive overall coronary plaque burden on a per-patient basis: CAC >1000; SIS >=8; or visual estimation of a severe amount of plaque in 2-3 vessels.	Report P4 after the stenosis category. A higher plaque burden may support more intensive preventive therapy consideration, but CAD-RADS 2.0 states that P categories are not absolute treatment thresholds and should be integrated with the impression and clinical context.	Extensive total coronary plaque burden; increasing plaque burden is associated with increasing cardiovascular risk independently of stenosis severity.	okfonte CAD-RADS 2.0 section 3.2.1 and Table 2 (P4 row); Tables 4-5 for management context
N	Modifier N, non-diagnostic study Non-diagnostic study or segment. If a diagnostic segment contains stenosis >=50%, retain the numeric CAD-RADS category and append N; if interpretable segments show at most 25-49% stenosis and at least one segment >1.5 mm is non-interpretable, N replaces the numeric category. Add P when total plaque burden remains reliably assessable.	Further evaluation is required when N replaces the numeric category because significant stenosis cannot be reliably excluded. When a diagnostic segment already establishes CAD-RADS >=3, append N and base downstream considerations on the demonstrated disease plus the residual uncertainty.	N represents diagnostic uncertainty rather than a stenosis-severity or event-risk grade.	okfonte CAD-RADS 2.0 section 3.3.1 (Modifier N) and Figures 11-12
HRP	Modifier HRP, high-risk plaque Add HRP when a single coronary plaque clearly demonstrates at least 2 high-risk features: positive remodeling (remodeling index >1.1), low-attenuation plaque (<30 HU), spotty calcification, or napkin-ring sign. Describe the specific features in the report text.	Do not use HRP in isolation to mandate invasive angiography. Integrate symptoms, stenosis, plaque burden, ischemia testing and the full clinical context; more aggressive preventive management may be considered in appropriate patients.	HRP features are associated with higher risk of acute coronary syndrome, future adverse cardiovascular events and lesion-specific ischemia, but their positive predictive value is modest when considered alone.	okfonte CAD-RADS 2.0 section 3.3.4 (High-risk plaque), Figures 15-16 and management discussion
I+	Modifier I+, positive ischemia Positive lesion-specific ischemia: CT-FFR <=0.75 in a vessel large enough for PCI, or myocardial CT perfusion showing reversible ischemia or peri-infarct ischemia.	In a symptomatic patient and an appropriate revascularization context, I+ may support consideration of invasive coronary angiography; integrate lesion location, symptoms, anatomy and all available imaging or stress-test findings.	Imaging evidence of lesion-specific or myocardial inducible ischemia; this modifier does not replace the anatomic CAD-RADS category.	okfonte CAD-RADS 2.0 section 3.3.5 and Tables 6-7 (ischemia modifier I+)
I-	Modifier I-, negative ischemia Negative lesion-specific ischemia: CT-FFR >0.80, or myocardial CT perfusion with no inducible ischemia. A fixed prior infarct is documented in the impression rather than treated as inducible ischemia.	When concordant with the anatomy and clinical context, I- may support deferral of invasive coronary angiography; it does not remove the need for preventive management indicated by plaque or stenosis.	No imaging evidence of inducible ischemia on the performed CT-based functional test; this is not equivalent to absence of coronary atherosclerotic risk.	okfonte CAD-RADS 2.0 section 3.3.5 and Tables 6-7 (ischemia modifier I-)
I+/-	Modifier I+/-, borderline or indeterminate ischemia Borderline or indeterminate ischemia: lesion-specific CT-FFR 0.76-0.80, or myocardial CT perfusion that is borderline or inconclusive for inducible ischemia.	Do not convert I+/- into a binary decision. Further decisions depend on lesion location, symptom severity, anatomy and, for CT-FFR, the trans-lesional gradient; CAD-RADS 2.0 notes a delta CT-FFR >0.12 as significant context.	Indeterminate functional significance; residual uncertainty must be stated explicitly.	okfonte CAD-RADS 2.0 section 3.3.5 and Tables 6-7 (ischemia modifier I+/-)
S	Modifier S, coronary stent present Add S when at least one coronary stent is present anywhere in the coronary system. Grade in-stent stenosis using the same stenosis bands as native coronary arteries.	S is a structural modifier, not a standalone management category; management follows the stenosis category, plaque burden, symptoms and clinical context.	Presence of a coronary stent; S alone is not a disease-severity or event-risk grade.	okfonte CAD-RADS 2.0 section 3.3.2 (Modifier S) and Figure 13
G	Modifier G, coronary bypass graft present Add G when at least one coronary bypass graft is present. Do not count a native stenosis proximal to a fully patent graft for CAD-RADS coding; assess grafts and native segments distal to and including the anastomosis. Assess plaque burden across native arteries and grafts together.	G is a structural modifier. Further management depends on stenosis or occlusion in the evaluated grafts and eligible native segments, plus symptoms and clinical context.	Presence of coronary bypass grafting; G alone is not a disease-severity or event-risk grade.	okfonte CAD-RADS 2.0 section 3.3.3 (Modifier G) and Figure 14
E	Modifier E, non-atherosclerotic exception Add E at the end of the CAD-RADS code for a non-atherosclerotic coronary abnormality or narrowing, including dissection, anomalous origin, aneurysm or pseudoaneurysm, vasculitis, fistula, extrinsic compression, arteriovenous malformation or another exception. The numeric category alone may not capture the abnormality.	Use disease-specific management considerations and/or subspecialty referral; do not treat the atherosclerotic CAD-RADS category as a complete management description for an E case.	Non-atherosclerotic coronary pathology whose risk is not represented by the atherosclerotic stenosis category alone.	okfonte CAD-RADS 2.0 Table 3 and section 3.3.6 (Modifier E)

Referências cruzadas

fronteira compartilhadaCAC. Coronary artery calcium (Agatston) categoriesCoronary CT: CAD-RADS grades luminal stenosis while the calcium score quantifies calcified plaque burden.

Histórico de versões

Data	Evento	Detalhe	Situação
2022-07-01	revised	CAD-RADS 2.0 released, updating the 2016 system.	confirmado

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