CAD-RADS 2.0 - Update on the evaluation and management of coronary artery disease with coronary CT angiography

The updated Coronary Artery Disease Reporting and Data System (CAD-RADS 2.0) adds new features for patients undergoing coronary CT angiography (CCTA). The following features are included in the new system: stenosis severity (categories 0, 1, 2, 3, 4A, 4B and 5), the overall amount of coronary plaque (from P1 to P4), classic modifiers (the study is not fully evaluable, presence of stents or grafts), new modifiers (if a myocardial ischemia test with CT is performed, I+ or I-), exceptions, and presence of high-risk plaques (HRP). This updated classification adds new features to guide patient management, including functional assessment in cases of CAD-RADS 3, CAD-RADS 4A, 4B and 5, and invasive coronary angiography in cases of CAD-RADS 3/I+, 4A, 4B and 5. This work aims to analyse the new modifications introduced in the updated system, understand the implications in patient management, and review teaching cases.