Coronary artery disease reporting and data system (CAD-RADS

Document Type

Article

Publication Date

3-1-2018

Publication Title

J Cardiovasc Comput Tomogr

Keywords

Computed Tomography Angiography, Coronary Angiography, Coronary Artery Bypass, Coronary Artery Disease, Coronary Vessels, Databases, Factual, Humans, Observer Variation, Percutaneous Coronary Intervention, Plaque, Atherosclerotic, Predictive Value of Tests, Reproducibility of Results, Research Design, Retrospective Studies, Risk Assessment, Stents, Vascular Calcification

Abstract

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/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.

Medical Subject Headings

Computed Tomography Angiography; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease; Coronary Vessels; Databases, Factual; Humans; Observer Variation; Percutaneous Coronary Intervention; Plaque, Atherosclerotic; Predictive Value of Tests; Reproducibility of Results; Research Design; Retrospective Studies; Risk Assessment; Stents; Vascular Calcification

PubMed ID

29217341

Volume

12

Issue

2

First Page

125

Last Page

130

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