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

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

**Situação:** vigente · **Órgão:** Cardíaco · **Órgão emissor:** SCCT / ACC / ACR / NASCI · **Versão:** 2.0 · **Ano:** 2022

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: CT
- Fonte primária: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002
- Última verificação: 2026-07-24
- Última checagem: 2026-07-24

## Lógica de decisão
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.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 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. | 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. | 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. | 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. | 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. | 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). | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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. | CAD-RADS 2.0 Table 3 and section 3.3.6 (Modifier E) | ✓ |

### Citações por categoria
- **0**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 stenosis categories table (CAD-RADS 0 row), per-patient maximal stenosis
- **1**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 stenosis categories table (CAD-RADS 1 row)
- **2**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 stenosis categories table (CAD-RADS 2 row)
- **3**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 stenosis categories table (CAD-RADS 3 row)
- **4A**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 stenosis categories table (CAD-RADS 4A row), per-patient maximal stenosis
- **4B**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 stenosis categories table (CAD-RADS 4B row), per-patient maximal stenosis
- **5**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 stenosis categories table (CAD-RADS 5 row)
- **P1**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 section 3.2.1 and Table 2 (P1 row); Tables 4-5 for management context
- **P2**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 section 3.2.1 and Table 2 (P2 row); Tables 4-5 for management context
- **P3**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 section 3.2.1 and Table 2 (P3 row); Tables 4-5 for management context
- **P4**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 section 3.2.1 and Table 2 (P4 row); Tables 4-5 for management context
- **N**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 section 3.3.1 (Modifier N) and Figures 11-12
- **HRP**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 section 3.3.4 (High-risk plaque), Figures 15-16 and management discussion
- **I+**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 section 3.3.5 and Tables 6-7 (ischemia modifier I+)
- **I-**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 section 3.3.5 and Tables 6-7 (ischemia modifier I-)
- **I+/-**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 section 3.3.5 and Tables 6-7 (ischemia modifier I+/-)
- **S**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 section 3.3.2 (Modifier S) and Figure 13
- **G**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 section 3.3.3 (Modifier G) and Figure 14
- **E**: Cury RC, Leipsic J, Abbara S, et al.. CAD-RADS 2.0: Coronary Artery Disease Reporting and Data System (2022) — https://doi.org/10.1016/j.jcct.2022.07.002 · CAD-RADS 2.0 Table 3 and section 3.3.6 (Modifier E)

## Referências cruzadas
- _fronteira compartilhada_ → [CAC — Coronary artery calcium (Agatston) categories](https://radcommons.laudos.ai/systems/cac-agatston.md) — Coronary 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. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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