(JACR)CAD-RADS_ 冠状动脉狭窄诊断标准

ORIGINALARTICLECAD-RADS
:CoronaryArteryDiseaseeReportingandDataSystem.AnExpertConsensusDocumentoftheSocietyofCardiovascularComputedTomography(SCCT),theAmericanCollegeofRadiology(ACR)andtheNorthAmericanSocietyforCardiovascularImaging(NASCI).EndorsedbytheAmericanCollegeofCardiologyRicardoC.Cury,MDa,SuhnyAbbara,MDb,StephanAchenbach,MDc,ArthurAgatston,MDd,DanielS.Berman,MDe,MatthewJ.Budoff,MDf,KarinE.Dill,MDg,JillE.Jacobs,MDh,ChristopherD.Maroules,MDi,GeoffreyD.Rubin,MDj,FrankJ.Rybicki,MD,PhDk,U.JosephSchoepf,MDl,LesleeJ.Shaw,PhDm,ArthurE.Stillman,MDn,CharlesS.White,MDo,PamelaK.Woodard,MDp,JonathonA.Leipsic,MDqAbstractTheintentofCAD-RADSeCoronaryArteryDiseaseReportingandDataSystemistocreateastandardizedmethodtocommunicatefindingsofcoronaryCTangiography(coronaryCTA)inordertofacilitatedecision-makingregardingfurtherpatientmanagement.ThesuggestedCAD-RADSclassificationisappliedonaper-patientbasisandrepresentsthehighest-gradecoronaryarterylesiondocumentedbycoronaryCTA.ItrangesfromCAD-RADS0(Zero)forthecompleteabsenceofstenosisandplaquetoCAD-RADS5forthepresenceofatleastonetotallyoccludedcoronaryarteryandshouldalwaysbeinterpretedinconjunctionwiththeimpressionfoundinthereport.SpecificrecommendationsareprovidedforfurthermanagementofpatientswithstableoracutechestpainbasedontheCAD-RADSclassification.ThemaingoalofCAD-RADSistostandardizereportingofcoronaryCTAresultsandtofacilitatecommunicationoftestresultstoreferringphysiciansalongwithsuggestionsforsubsequentpatientmanagement.Inaddition,CAD-RADSwillprovideaframeworkofstandardizationthatmaybenefiteducation,research,peer-reviewandqualityassurancewiththepotentialtoultimatelyresultinimprovedqualityofcare.KeyWords:Coronaryarterydisease,coronaryCTA,CAD-RADS,reportinganddatasystem,stenosisseverity,reportstandardizationterminologyJAmCollRadiol2016;-:---.2016SocietyofCardiovascularComputedTomographyandtheAmericanCollegeofRadiology.PublishedbyElsevierInc.Allrightsreserved.aMiamiCardiacandVascularInstitute,BaptistHospitalofMiami,8900NKendallDrive,Miami,FL,33176,UnitedStates.bDepartmentofRadiology,5323HarryHinesBlvd,Dallas,TX,75390,UnitedStates.cFriedrich-Alexander-Universität,Erlangen-Nürnberg,DepartmentofCar-diology,Ulmenweg18,90154,Erlangen,Germany.dBaptistHealthMedicalGrp,1691MichiganAvenue,Miami,FL,33139,UnitedStates.eCedars-SinaiMedCenter,8700BeverlyBoulevard,TaperBuilding,Rm1258,LosAngeles,CA,90048,UnitedStates.f1124W.CarsonStreet,Torrance,CA,90502,UnitedStates.g5841SouthMarylandAve,MC2026,Chicago,IL,60637,UnitedStates.h550FirstAvenue,NewYork,NY,10016,UnitedStates.iDepartmentofRadiology,5323HarryHinesBlvd,Dallas,TX,75390,UnitedStates.j2400PrattStreet,Room8020,DCRIBox17969,Durham,NC,27715,UnitedStates.kTheOttawaHospitalGeneralCampus,501SmythRd,Ottawa,ON,CAK1H8L6,Canada.l25CourtenayDr.,Charleston,SC,29425,UnitedStates.m1256BriarcliffRd.NE,Rm529,Atlanta,GA,30324,UnitedStates.n1364CliftonRoad,NE,Atlanta,GA,30322,UnitedStates.oUniversityofMaryland,22S.GreeneSt.,Baltimore,MD,21201,UnitedStates.pMallinckrodtInstitofRadiology,510SKingshighwayBlvd,St.Louis,MO,63110,UnitedStates.qDepartmentofRadiology,St.Paul’sHospital,2ndFloor,ProvidenceBuilding,1081BurrardStreet,Vancouver,BC,V6Z1Y6,UnitedStates.Correspondingauthorandreprints:RicardoC.Cury,MD,MiamiCardiacandVascularInstitute,BaptistHospitalofMiami,8900NKendallDrive,Miami,FL33176;e-mail:[e-mail].ª2016SocietyofCardiovascularComputedTomographyandtheAmericanCollegeofRadiology.PublishedbyElsevierInc.Allrightsreserved.1546-1440/16/$36.00n©2016.ElsevierInc.Allrightsreserved.CONDENSEDABSTRACTCAD-RADSisastandardizedreportingsystemforcor-onaryCTAresultsonaper-patientbasis.Itisintendedtoimprovecommunicationofresultstoreferringphysiciansinaconsistentfashion,includingrecommendationsforfurthermanagement.Theachievedstandardizationofreportingwillbenefiteducation,research,peerreviewandqualityassuranceandmayultimatelyresultinimprovedqualityofcare.1.INTRODUCTIONCoronaryCTAngiography(coronaryCTA)hasmadesubstantialprogresssincetheintroductionof64-sliceCTscannersapproximately10yearsago[1],bothconcerningimagingtechnologyandclinicalvalidation.Inparallel,severalprofessionalsocietieshaveissuedguidelines,expertconsensusdocuments,andAppropriatenessCriteriaforcoronaryCTA[2-8].TomaximizetheclinicalimpactofcoronaryCTA,imagingprotocolsmustbeoptimizedwithrespecttoimagequality,diagnosticaccuracy,andradiationdose.Trainingandinterpretationstandardsareimportant.Finally,standardizedreportingishelpfultodecreasevariabilityamongpractitionersandmayprovidefurtherbenefitbylinkingthefinalimpressioninthereportwithsuggestionsforfurtherpatientmanagement.Otherfieldsinmedicalimaging(notably,breastimag-ingwithBI-RADS)haveintroducedstandardizedreportinglinkedwithactionableinformationtoguidenextstepsinpatientmanagement[9].BI-RADSstandardizedreportingofscreeningmammogramsallowsclinicianstointerprettheclinicalrelevanceofr