Coronary artery disease reporting and data system (CAD-RADS
Maroules CD, Hamilton-Craig C, Branch K, Lee J, Cury RC, Maurovich-Horvat P, Rubinshtein R, Thomas D, Williams M, Guo Y, Cury RC. Coronary artery disease reporting and data system (CAD-RADS(TM)): Inter-observer agreement for assessment categories and modifiers. J Cardiovasc Comput Tomogr. 2018 Mar - Apr;12(2):125-130.
J Cardiovasc Comput Tomogr
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