CAD-RADS 2.0 Calculator

Coronary Artery Disease - Reporting and Data System (2022 Expert Consensus)

Current CAD-RADS
CAD-RADS 0
1
Clinical Context
2
Stenosis
3
Plaque Burden
4
High-Risk Plaque
5
Ischemia
6
Modifiers

Clinical Presentation

CAD-RADS 2.0 provides context-specific management recommendations based on whether the patient presents with stable or acute chest pain.

Stable Chest Pain

Outpatient evaluation, chronic symptoms, elective workup

Acute Chest Pain

Emergency presentation, acute coronary syndrome evaluation

Coronary Artery Stenosis

Adjust the sliders to indicate maximum stenosis in each vessel. CAD-RADS is determined by the single worst stenosis across all vessels. Left Main ≥50% = CAD-RADS 4B regardless of other findings.

LM

Left Main

Critical: ≥50% stenosis = CAD-RADS 4B
0%
Normal
Left main ≥50% automatically classifies as CAD-RADS 4B
LAD

Left Anterior Descending

Proximal LAD is high-risk location
0%
Normal
LCx

Left Circumflex

Left coronary system
0%
Normal
RCA

Right Coronary Artery

Right coronary system
0%
Normal
D

Diagonal Branch

LAD branch vessel
0%
Normal
OM

Obtuse Marginal

LCx branch vessel
0%
Normal

Plaque Burden Assessment (P1-P4)

CAD-RADS 2.0 requires plaque burden grading because total plaque burden predicts MACE independently of stenosis severity. Assess using CAC score, Segment Involvement Score (SIS), or visual estimate. Use the highest category if methods disagree.

P1
Mild
Limited plaque in few segments, low calcification
P2
Moderate
Intermediate plaque burden
P3
Severe
Heavy plaque in multiple segments/vessels
P4
Extensive
Diffuse multivessel plaque, very high burden
Assessment Methods (choose most appropriate):
  • CAC Score: Agatston method (combine with visual non-calcified plaque assessment)
  • Segment Involvement Score (SIS): Count segments with any plaque (0-16)
  • Visual Estimate: Overall calcified + non-calcified plaque burden

High-Risk Plaque (HRP) Features

HRP modifier requires ≥2 features. Meta-analysis shows ≥2 HRP features → 9.17× increased MACE risk. Even for non-obstructive lesions (CAD-RADS 1-2), HRP presence warrants aggressive prevention.

Low-Attenuation Plaque

Plaque with density <30 HU (lipid-rich core)

Positive Remodeling

Vessel enlargement at plaque site (remodeling index >1.1)

Spotty Calcification

Small, scattered calcific deposits within plaque

Napkin-Ring Sign

Low-density core surrounded by higher-density rim

Select features above. HRP modifier requires ≥2 features.

Ischemia Assessment (Optional)

The Ischemia modifier (I+/I-/I+/-) is added only if CT-FFR or stress CTP was performed. This enhances management decisions especially for CAD-RADS 3-4.

Ischemia assessment performed (CT-FFR or Stress CTP)
Assessment Method
CT-FFR
Fractional Flow Reserve derived from CT
Stress CTP
Stress CT Perfusion
Result
I+ Positive
FFR ≤0.75 or reversible perfusion defect
I+/- Borderline
FFR 0.76-0.80 or indeterminate
I- Negative
FFR >0.80 or no ischemia

Additional Modifiers

CAD-RADS 2.0 modifier order: Stenosis/Plaque/N/HRP/I/S/G/E. Select any applicable modifiers below.

N - Non-Diagnostic

Study not fully evaluable (motion, calcium blooming, metal artifact)

S - Stent

Coronary stent(s) present

G - Graft

Coronary bypass graft(s) present

E - Exception

Non-atherosclerotic abnormality (anomaly, dissection, aneurysm, vasculitis)

CAD-RADS 0
No coronary artery disease detected

Impression

Management

    Vessels

    Clinical Notes i MACE = Major Adverse Cardiovascular Events: cardiac death, myocardial infarction (MI), unstable angina requiring hospitalization, or coronary revascularization.