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Published on: August 9, 2024
Coronary artery disease reporting and data system (CAD-RADSTM): Inter-observer agreement for assessment categories
Christopher D Maroules1, Christian Hamilton-Craig2, Kelley Branch3
1Department of Radiology, Naval Medical Center, Portsmouth, VA, United States; Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, United States.
Insights
The Coronary Artery Disease Reporting and Data System (CAD-RADS) shows excellent inter-observer agreement for reporting coronary CT angiography, suggesting feasibility for clinical use. Agreement is slightly better with expert readers and high image quality, though fair for high-risk plaque.
Area of Science:
- Cardiovascular Imaging
- Radiology Reporting Systems
Background:
- The Coronary Artery Disease Reporting and Data System (CAD-RADS) standardizes reporting for coronary CT angiography.
- Standardized reporting systems are crucial for consistent interpretation of complex imaging data.
Purpose of the Study:
- To evaluate the inter-observer agreement of the CAD-RADS lexicon among cardiac imaging readers.
- To assess the impact of reader experience and image quality on CAD-RADS agreement.
Main Methods:
- Four early career and four expert readers independently evaluated 50 coronary CT angiography cases using CAD-RADS.
- Image quality was assessed on a Likert scale; agreement was measured using intra-class correlation (ICC) and Fleiss' Kappa (κ).
- Reader experience and image quality effects on agreement were analyzed.
Main Results:
- Excellent inter-observer agreement was found for CAD-RADS assessment categories (ICC 0.958).
- Agreement was marginally stronger in expert readers and with high image quality.
- Excellent agreement was observed for stent (S) and bypass graft (G) modifiers, but only fair agreement for high-risk plaque (V) (κ=0.40).
Conclusions:
- CAD-RADS demonstrates excellent inter-observer reproducibility for assessment categories and most modifiers.
- Modifier V (high-risk plaque) showed only fair agreement, warranting further attention.
- The findings support the clinical feasibility of implementing CAD-RADS.
Background:
The Coronary Artery Disease Reporting and Data System (CAD-RADS) provides a lexicon and standardized reporting system for coronary CT angiography.
Objectives:
To evaluate inter-observer agreement of the CAD-RADS among an panel of early career and expert readers.
Methods:
Four early career and four expert cardiac imaging readers prospectively and independently evaluated 50 coronary CT angiography cases using the CAD-RADS lexicon. All readers assessed image quality using a five-point Likert scale, with mean Likert score ≥4 designating high image quality, and <4 designating moderate/low image quality. All readers were blinded to medical history and invasive coronary angiography findings. Inter-observer agreement for CAD-RADS assessment categories and modifiers were assessed using intra-class correlation (ICC) and Fleiss' Kappa (κ).The impact of reader experience and image quality on inter-observer agreement was also examined.
Results:
Inter-observer agreement for CAD-RADS assessment categories was excellent (ICC 0.958, 95% CI 0.938-0.974, p < 0.0001). Agreement among expert readers (ICC 0.925, 95% CI 0.884-0.954) was marginally stronger than for early career readers (ICC 0.904, 95% CI 0.852-0.941), both p < 0.0001. High image quality was associated with stronger agreement than moderate image quality (ICC 0.944, 95% CI 0.886-0.974 vs. ICC 0.887, 95% CI 0.775-0.95, both p < 0.0001). While excellent inter-observer agreement was observed for modifiers S (stent) and G (bypass graft) (both κ = 1.0), only fair agreement (κ = 0.40) was observed for modifier V (high risk plaque).
Conclusion:
Inter-observer reproducibility of CAD-RADS assessment categories and modifiers is excellent, except for high-risk plaque (modifier V) which demonstrates fair agreement. These results suggest CAD-RADS is feasible for clinical implementation.
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