Society of Cardiovascular Computed Tomography / North American Society of Cardiovascular Imaging - Expert Consensus Document on Coronary CT Imaging of Atherosclerotic Plaque.

Weill Cornell School of Medicine, New York, NY, USA. Electronic address: les2035@med.cornell.edu. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. University of Leiden, Leiden, the Netherlands. Oregon Health and Science University, Portland, OR, USA. University of Sao Paulo, Sao Paulo, Brazil. Weill Cornell School of Medicine; Cleerly, Inc. (started in 2020), New York, NY, USA. Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. University of British Columbia, Vancouver, Canada. University of Virginia, Charlottesville, VA, USA. Cedars-Sinai Medical Center, Los Angeles, CA, USA. Weill Cornell School of Medicine, New York, NY, USA. University of Edinburgh, Edinburgh, Scotland, United Kingdom. Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, FL, USA. Leiden University Medical Center, Leiden, the Netherlands. David Geffen School of Medicine, UCLA, Los Angeles, CA, USA. Yonsei University, Seoul, South Korea. Mount Sinai School of Medicine, New York, NY, USA. Innsbruck Medical University, Innsbruck, Austria. Massachusetts General Hospital, Boston, MA, USA. University of Minnesota, Minneapolis, MN, USA.

Journal of cardiovascular computed tomography. 2021;(2):93-109
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Abstract

Coronary computed tomographic angiography (CCTA) provides a wealth of clinically meaningful information beyond anatomic stenosis alone, including the presence or absence of nonobstructive atherosclerosis and high-risk plaque features as precursors for incident coronary events. There is, however, no uniform agreement on how to identify and quantify these features or their use in evidence-based clinical decision-making. This statement from the Society of Cardiovascular Computed Tomography and North American Society of Cardiovascular Imaging addresses this gap and provides a comprehensive review of the available evidence on imaging of coronary atherosclerosis. In this statement, we provide standardized definitions for high-risk plaque (HRP) features and distill the evidence on the effectiveness of risk stratification into usable practice points. This statement outlines how this information should be communicated to referring physicians and patients by identifying critical elements to include in a structured CCTA report - the presence and severity of atherosclerotic plaque (descriptive statements, CAD-RADS™ categories), the segment involvement score, HRP features (e.g., low attenuation plaque, positive remodeling), and the coronary artery calcium score (when performed). Rigorous documentation of atherosclerosis on CCTA provides a vital opportunity to make recommendations for preventive care and to initiate and guide an effective care strategy for at-risk patients.

Methodological quality

Publication Type : Review

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