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CAD-RADS 2.0: Comparison of methods for assessment of plaque burden

Ivan Platzek1, Krzysztof Nocon1, Suela Mema1

  • 1Dresden University Hospital, Department of Radiology, Dresden, Germany.

European Journal of Radiology Open
|April 30, 2026
PubMed

Insights

The agreement between coronary artery calcium (CAC) testing, segment involvement score (SIS), and visual estimate for assessing coronary plaque burden varies, with moderate to substantial agreement found between methods. The chosen method significantly influences Coronary Artery Disease-Reporting and Data System (CAD-RADS) results.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Coronary artery disease (CAD) assessment relies on accurate plaque burden evaluation.
  • The Coronary Artery Disease-Reporting and Data System (CAD-RADS) classification uses multiple methods for plaque assessment.
  • Understanding the agreement between these methods is crucial for consistent reporting.

Purpose of the Study:

  • To evaluate the agreement between three CAD-RADS 2.0 approved methods for coronary plaque burden assessment: coronary artery calcium (CAC) testing, segment involvement score (SIS), and visual estimate.
  • To determine if these methods are interchangeable in clinical practice.

Main Methods:

  • Retrospective analysis of 132 patients with stable chest pain undergoing coronary computed tomography angiography (CCTA).
  • Independent evaluation of CCTA by two radiologists to determine plaque burden using P(CAC), P(SIS), and P(visual) estimates.
  • Assessment of inter-method agreement using linearly weighted kappa statistics.

Main Results:

  • The study included 132 patients (mean age 66.6 years, 68.2% male).
  • Weighted Kappa values indicated moderate to substantial agreement: κ=0.56 (P(CAC) vs. P(SIS)), κ=0.67 (P(CAC) vs. P(visual)), and κ=0.72 (P(SIS) vs. P(visual)).
  • CAD-RADS classifications varied based on the plaque burden assessment method used.

Conclusions:

  • The choice of plaque burden assessment method significantly impacts CAD-RADS 2.0 results.
  • The three methods (CAC, SIS, visual estimate) are not interchangeable and capture different aspects of plaque burden.
  • It is essential to explicitly state the method used when reporting plaque burden within the CAD-RADS 2.0 framework.
Abstract

Keywords:
Coronary Artery Disease-Reporting and Data SystemCoronary computed tomography angiographyMethod agreementPlaque burdenSegment involvement score

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