CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

28 9月

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

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。

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布
CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

 CAD-RADS——图片详析

Fig. 1. CAD-RADS 0. Normal left main, LAD, LCX and RCA without plaque or stenosis.【 左主干正常,LAD、LCX和RCA无斑块或狭窄。】

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

Fig. 2.CAD-RADS 1. Minimal calcified plaque in the proximal LAD with minimal luminal narrowing (less than 25% diameter stenosis).【LAD近端极小的微钙化斑块,极小的管腔狭窄(狭窄直径<25%)】

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

Fig. 3.CAD-RADS 2.Predominantly calcified plaque in the proximal LAD with 25-49% diameter stenosis (left). Invasive coronary angiography confirming 25-49% stenosis (right).【主要钙化斑块在LAD近端,狭窄直径25%~49%(左)。冠脉介入造影证实25%~49%的狭窄(右)】

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

Fig. 4.CAD-RADS 3. Predominantly calcified plaque in the mid LCX with 50-69% diameter stenosis. Left image: Coronary CTA. Right image: Invasive coronary angiography.【主要钙化斑块在LAD中段,狭窄直径50%~69%。左图:冠脉CTA。右图:冠脉介入造影。】

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

Fig. 5.CAD-RADS 4A.  Focal non-calcified plaque in the mid LAD (yellow arrow) with 70-99% diameter stenosis (left). Invasive coronary angiography confirming 70-99% stenosis in the mid LAD (yellow arrow, right). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)【LAD中段非钙化斑块(黄色箭头),狭窄直径70%~99%(左)。冠脉介入造影证实LAD中段70%~99 %的狭窄(黄色箭头,右)。】

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

Fig. 6.CAD-RADS 4B.  Three-vessel obstructive disease (>70% stenosis), including in 70-99% stenosis of the proximal RCA (left), 70-99% stenosis of the proximal LAD (middle) and in70-99% stenosis of the mid LCX (right).【三支血管闭塞(狭窄>70%),包括RCA近端狭窄70%~99%(左),LAD近端狭窄70%~99%(中),LCX中段狭窄70%~99%(右)。】

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

Fig. 7.CAD-RADS 4B.  Distal left main stenosis with circumferential calcified plaque resulting in >50% stenosis (arrow). Upper left panel: oblique longitudinal plane of the left main coronary artery. Lower left panel e cross-sectional slice of the distal left main coronary artery. Figures on the right – Invasive coronary angiography confirming focal severe stenosis in the distal left main coronary artery.

【左主干远端环钙化斑块导致>50%的狭窄(箭头)。左上:左主干斜纵切面。左下:左主干远端横切面。右图:冠脉造影证实左主干远端严重狭窄。】

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

Fig. 8.CAD-RADS 5.  Two examples of cases coded as CAD-RADS 5. Left: Focal, non-calcified occlusion of the proximal RCA (arrow). Right: Total occlusion of the proximal LCX (arrow). A small focus of “orphan” calcium along the distal LCX supports the diagnosis of chronic total occlusion.【左: RCA近端非钙化闭塞(箭头)。右:LCX近端全部闭塞(箭头)。LCX远端一个小的”孤立”钙化,支持慢性完全闭塞病变的诊断。】

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

Fig. 9.CAD-RADS N. Motion artifacts obscuring the left main, LAD and LCX arteries, which renders these segments non-diagnostic (left). Motion artifacts in the mid RCA (right).【运动伪影遮盖了左主干、LAD和LCX,使这些部分不能诊断(左)。运动伪影在RCA中期(右)。RCA中段的运动伪影(右)】

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

Fig. 10.CAD-RADS 3/N. Motion artifact obscuring the mid RCA (left, arrow), which renders this segment non-diagnostic. There is also stenosis of the mid LAD with 50-69% luminal narrowing (right, arrow), qualifying this lesion as CAD RADS 3. Although the mid RCA segment is non-diagnostic, the presence of suspected obstructive disease within the LAD should be coded as CAD RADS 3/N. If the LAD lesion were mild (less than 50% diameter stenosis), and no other plaques were identified, the patient would be coded as CAD RADS N.【运动伪影遮盖了RCA中段(左图,箭头),使这些部分不能诊断。LAD中段管腔狭窄50%~69%(右图,箭头),这部分病变符合CAD-RADS 3。虽然RCA中段不能诊断,LAD疑似闭塞应标记为CAD-RADS 3/N。若LAD轻度病变(直径狭窄<50%),未发现其他斑块,患者应标记为CAD-RADS N。】

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

Fig. 11.CAD-RADS 4A/S. In-stent stenosis of the proximal LAD with significant luminal narrowing (70-99% stenosis). Grading of in-stent stenosis should follow the grading of normal coronary arteries (0% stenosis, 1-24% stenosis, 25-49% stenosis, 50-69% stenosis, 70-99% stenosis, and >99% stenosis). In this case, severe in-stent restenosis designates a CAD-RADS 4A lesion, which would be followed by the stent modifier “S.”【LAD近端支架内再狭窄,有显著管腔狭窄(狭窄70%~99%)。支架内再狭窄分级应遵循正常冠状动脉评分(0%狭窄,1%~24%狭窄,25%~49%狭窄,50%~69%狭窄,70%~99%狭窄,>99%狭窄)。在这种情况下,将严重的支架内再狭窄定义为CAD-RADS 4A病变。】

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

Fig. 12.CAD-RADS 2/V. Focal non-calcified plaque in the mid RCA with 25-49% diameter stenosis. The plaque demonstrates two high risk features, low attenuation (<30 HU) and positive remodeling, thus coding with the modifier “V.”【右冠中段局灶性非钙化斑块,狭窄约25-49%。该斑块显示两个高风险因素,低密度(<30HU)和正性重塑,因此标记为CAD-RADS 2/V。】
CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

Fig. 13.CAD-RADS 3/S/V. Example demonstrating a patent stent in the proximal RCA (0% stenosis) with high-risk plaque in the proximal LAD resulting in 50-69% stenosis. In isolation, the proximal LAD lesion would be coded CAD RADS 3/V. However, since CAD RADS is coded on a per-patient basis, and a RCA stent is present, this patient would be coded as CAD RADS 3/S/V.【右冠支架术后,管腔狭窄0%,前降支高危斑块管腔狭窄50-69%。孤立的看,前降支病变标记CAD RADS 3/V,然而因右冠支架存在,此病人标记CAD RADS 3/S/V.】

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布
CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

CAD-RADS—冠脉CTA报告规范,美三大医学会最新权威发布

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