Coronary Artery Disease Reporting and Data System: A Comprehensive Review

Figures

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  Figure 1. Coronary Artery Disease Reporting and Data System 0 in a 45-year-old man with a history of chronic chest pain. Curved multiplanar reformatted computed tomography angiographic image of the RCA, LAD artery, and LCx artery reveal normal coronary arteries with no atherosclerotic disease or stenosis. No further imaging was recommended. CX: circumflex artery, DIST: distal, LAD: left anterior descending, LCx: left circumflex, LMCA: left main coronary artery, PDA: posterior descending artery, RCA: right coronary artery.

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  Figure 2. Coronary Artery Disease Reporting and Data System 1 in a 38-year-old man with atypical chest pain. Curved multiplanar reformatted computed tomography angiographic image show a discrete partially calcified plaque in the proximal LAD (white arrowhead) causing minimal stenosis (<25%). No further imaging was recommended. LAD: left anterior descending.

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  Figure 3. Coronary Artery Disease Reporting and Data System 2 in a 56-year-old man with chronic chest pain. Curved multiplanar reformatted computed tomography image of the RCA reveals a noncalcified plaque (white arrowhead) causing mild stenosis (25%–49%). No further imaging was recommended. AM1: first acute marginal, AM2: second acute marginal, RCA: right coronary artery.

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  Figure 4. Coronary Artery Disease Reporting and Data System 3 in a 72-year-old woman with atypical chest pain. Curved multiplanar reformatted computed tomography angiographic image of LAD shows a partially calcified plaque (white arrowhead) in the proximal part causing moderate stenosis (50%–69%). Functional assessment was recommended. Myocardial perfusion scintigraphy (not shown) showed a stress perfusion defect in the mid anterior and anteroseptal segments, which is consistent with ischemia. DIST: distal, LAD: left anterior descending, LMCA: left main coronary artery.

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  Figure 5. Coronary Artery Disease Reporting and Data System 4A in a 56-year-old woman who presented with chest pain on exertion and abnormal electrocardiogram results. Curved multiplanar reformatted computed tomography angiographic image shows a predominantly noncalcified plaque (white arrowhead) in the mid RCA causing severe luminal stenosis (70%–99%). No other significant coronary artery disease was detected. ICA was recommended. ICA results (not shown) showed severe stenosis in the RCA artery, which was treated with balloon angioplasty and stent placement. DIST: distal, ICA: invasive coronary angiography, PDA: posterior descending artery, RCA: right coronary artery.

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  Figure 6. Coronary Artery Disease Reporting and Data System 4B in a 65-year-old man who presented with shortness of breath and chest pain. (A) Curved multiplanar reformatted computed tomography angiographic image and (B) the corresponding axial reformatted image of the LM artery shows circumferential calcified plaque (white arrowheads) causing >50% stenosis. Moderate stenosis was seen in right coronary artery and mild stenosis was seen in the left anterior descending and left circumflex (not shown). Invasive coronary angiography was recommended which revealed triple vessel disease. The patient was considered for coronary artery bypass grafting. LM: left main coronary artery.

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  Figure 7. Coronary Artery Disease Reporting and Data System 5 in a 59-year-old man who presented with acute chest pain. Maximum intensity projection computed tomography angiographic image of the RCA shows total occlusion in the mid part (white arrowhead). Invasive coronary angiography findings (not shown) confirmed occlusion of the RCA artery. RCA: right coronary artery.

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  Figure 8. Coronary Artery Disease Reporting and Data System N in a 40-year-old woman who presented with chronic chest pain. Curved maximum intensity projection computed tomography angiographic image of coronary arteries shows no atherosclerotic disease in the RCA, LCx, and proximal LAD. The mid LAD could not be evaluated because of a motion artifact (white arrowhead). Additional or alternative evaluation was recommended. LAD: left anterior descending, LCx: left circumflex, RCA: right coronary artery.

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  Figure 9. Modifier N in a 56-year-old man with chest pain. (A) Curved MPR CT angiographic image of the LAD shows a non-calcified plaque (white arrowhead) causing moderate stenosis (50%–69%) in the proximal part. (B) Curved MPR CT angiographic image of LCx shows no atherosclerotic disease. (C) Axial reformatted CT angiographic image of RCA shows a non-evaluable segment in the mid part because of motion artifacts. The patient was assigned Coronary Artery Disease Reporting and Data System 3/N category. ICA was recommended. The patient underwent ICA (not shown), which confirmed moderate stenosis (70%) in the mid RCA. CT: computed tomography, ICA: invasive coronary angiography, LAD: left anterior descending, LCx: left circumflex, MPR: multiplanar reformatted, RCA: right coronary artery.

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  Figure 10. Modifier S (stent) in a 59-year-old woman with new-onset chest pain who had a history of inferior myocardial infarction and stent placement in the RCA. Curved multiplanar reformatted computed tomography angiographic image of the RCA shows a long stent in situ with moderate in stent restenosis (50%–69%) (white arrowhead). Minimal disease was seen in the left anterior descending and left circumflex arteries (not shown). The patient was assigned Coronary Artery Disease Reporting and Data System 3/S category. Functional assessment was recommended. RCA: right coronary artery.

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  Figure 11. Coronary Artery Disease Reporting and Data System 4A/S in a 75-year-old man with new onset chest pain and a history of myocardial infarction and stent placement in D1 branch. (A) Curved MPR CT angiographic image of the LAD shows a patent stent in D1. No evidence of in stent restenosis was seen. (B) Curved MPR CT angiographic image of the RCA shows a non-calcified plaque causing severe stenosis (70%–99%) in the proximal part (white arrowhead). ICA was recommended. ICA results (not shown) showed severe stenosis in the RCA artery, which was treated with balloon angioplasty and stent placement. CT: computed tomography, D1: 1st diagonal, ICA: invasive coronary angiography, LAD: left anterior descending, LMCA: left main coronary artery, MPR: multiplanar reformatted, RCA: right coronary artery.

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  Figure 12. Coronary Artery Disease Reporting and Data System N/S in a 69-year-old woman with new onset chest pain and a history of myocardial infarction and stent placement in the LAD (A) Curved multiplanar reformatted CT angiographic image of the LAD shows a long patent stent in situ. No evidence of in stent restenosis seen. (B) Axial reformatted CT angiographic image of the RCA shows a non-evaluable segment in the mid part because of motion artifacts (white arrow). Left circumflex was normal. Invasive coronary angiography was recommended and revealed mild stenosis in the mid RCA (not shown). CT: computed tomography, LAD: left anterior descending, RCA: right coronary artery.