Coronary Artery Calcium Data and Reporting System

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CAC-DRS (Coronary Artery Calcium Data and Reporting System) is a structured reporting scheme for all non-contrast CT scans in the evaluation of coronary artery disease, which can help in communication between clinicians and radiologists. This document has been recommended by the SCCT (Society of Cardiovascular Computed Tomography) and STR (Society of Thoracic Radiology)Guideline ¹.

This system will apply to all dedicated CAC scans and all nongated non-contrast chest CT. Radiologists can interpret both visually and quantitatively with Agatston score.

Interpretation categories and management recommendations.

Agatston Score (A)

CAC-DRS A0:

CAC Score = 0
Very low risk
Statin generally not recommended (excluding familial hypercholesterolemia).

CAC-DRS A1:

CAC Score = 1–99
Mildly increased risk.
Moderate intensity statin.

CAC-DRS A2:

CAC Score = 100–299
Moderately increased risk.
Moderate to high-intensity statin + ASA (acetylsalicylic acid) 81mg.

CAC-DRS A3:

CAC Score > 300
Moderately to severely increased risk.
High intensity statin + ASA (acetylsalicylic acid) 81mg.

Visual Score (V)

The visual score may be utilized for non-contrast non-gated studies but should not be applied to gated CAC scans.

CAC-DRS V0:

CAC Visual Score = 0
Very low risk
Statin generally not recommended (excluding familial hypercholesterolemia).

CAC-DRS V1:

CAC Visual Score = 1
Mildly increased risk.
Moderate intensity statin.

CAC-DRS V2:

CAC VisualScore = 2
Moderately increased risk.
Moderate to high-intensity statin + ASA (acetylsalicylic acid) 81mg.

CAC-DRS V3:

CAC VisualScore = 3
Moderately to severely increased risk.
High intensity statin + ASA (acetylsalicylic acid) 81mg.

Example reports.

~~Unlike~~By comparison the Agatston ~~index~~score in this scale uses a different ~~threshold value~~grading of calcification (1-300), as well as an additional modifier (N). Additional modifier (N) is used to characterize the number of affected coronary arteries.

Agatston Score (A)

CAC-DRS A0: CAC 0
CAC-DRS A1/N3: CAC 1–99 in LM, LAD and LCx
CAC-DRS A2/N3: CAC 100–299 in LAD, LCX and RCA
CAC-DRS A3/N4: CAC > 300 in LM, LAD, LCx and RCA

Visual Score (V)

CAC-DRS V0: CAC 0
CAC-DRS V1/N3: CAC 1 in LM, LAD and LCx
CAC-DRS V2/N3: CAC 2 in LAD, LCX and RCA
CAC-DRS V3/N4: CAC 3 in LM, LAD, LCx and RCA

Incidental findings in CAC-DRS reports.

Pericardium (for example pericardium effusion, pericarditis)
Ascending aorta (normal less than 4 cm)
Descending aorta (normal less than 3 cm)
Pulmonary trunk (normal less than 29 mm)
Extra-coronary calcification (aortic valve or wall calcification, mitral valve calcification)
Other findings (lung nodule).

-<p><strong>CAC-DRS (Coronary Artery Calcium Data and Reporting System)</strong> is a structured reporting scheme for all non-contrast CT scans in the evaluation of <a title="coronaryartery disease" href="/articles/coronaryartery-disease">coronary artery disease</a>, which can help in communication between clinicians and radiologists. This document has been recommended by the SCCT (Society of Cardiovascular Computed Tomography) and STR (Society of Thoracic Radiology)<br>Guideline <sup>1</sup>.</p><p>This system will apply to all dedicated CAC scans and all nongated non-contrast chest CT. Radiologists can interpret both visually and quantitatively with <a title="Agatston score" href="/articles/agatston-score">Agatston score</a>.</p><h4>Interpretation categories and management recommendations.</h4><p> </p><h5>Agatston Score (A)</h5><p><strong>CAC-DRS A0:</strong></p><ul>
+<p><strong>CAC-DRS (Coronary Artery Calcium Data and Reporting System)</strong> is a structured reporting scheme for all non-contrast CT scans in the evaluation of <a href="/articles/coronaryartery-disease">coronary artery disease</a>, which can help in communication between clinicians and radiologists. This document has been recommended by the SCCT (Society of Cardiovascular Computed Tomography) and STR (Society of Thoracic Radiology) Guideline <sup>1</sup>.</p><p>This system will apply to all dedicated CAC scans and all nongated non-contrast chest CT. Radiologists can interpret both visually and quantitatively with <a href="/articles/agatston-score">Agatston score</a>.</p><h4>Interpretation categories and management recommendations.</h4><h5>Agatston Score (A)</h5><p><strong>CAC-DRS A0:</strong></p><ul>
~~-<li>Very low risk </li>~~
+<li>Very low risk</li>
~~-<li>CAC Visual Score = 2</li>~~
+<li>CAC Visual Score = 2</li>
~~-<li>CAC Visual Score = 3</li>~~
+<li>CAC Visual Score = 3</li>
-</ul><h4>Example reports.</h4><p>Unlike the Agatston index in this scale uses a different threshold value of calcification (1-300), as well as an additional modifier (N). Additional modifier (N) is used to characterize the number of affected coronary arteries. </p><h6>Agatston Score (A)</h6><ul>
+</ul><h4>Example reports.</h4><p>By comparison the Agatston score in this scale uses a different grading of calcification (1-300), as well as an additional modifier (N). Additional modifier (N) is used to characterize the number of affected coronary arteries. </p><h6>Agatston Score (A)</h6><ul>
~~-</ul><p><strong style="font-size:1.2em; font-weight:bold">Visual Score (V)</strong></p><ul>~~
+</ul><h6><strong>Visual Score (V)</strong></h6><ul>
-<li>Pericardium (for example <a title="pericardium effusion" href="/articles/pericardium-effusion">pericardium effusion</a>, <a title="pericarditis" href="/articles/pericarditis">pericarditis</a>)</li>
~~-<li>Ascending aorta (normal less than <a title="4 cm" href="/articles/ascending-aorta-dilatation">4 cm</a>)</li>~~
+<li>Pericardium (for example <a href="/articles/pericardium-effusion">pericardium effusion</a>, <a href="/articles/pericarditis">pericarditis</a>)</li>
+<li>Ascending aorta (normal less than <a href="/articles/ascending-aorta-dilatation">4 cm</a>)</li>
~~-<li>Pulmonary trunk (normal less than <a title="29 mm)" href="/articles//pulmonary-trunk">29 mm)</a>~~
+<li>Pulmonary trunk (normal less than <a href="/articles//pulmonary-trunk">29 mm)</a>
~~-<li>Extra-coronary calcification (aortic valve or wall calcification, <a title="mitral valve calcification" href="/articles/mitral-valve-calcification">mitral valve calcification</a>)</li>~~
~~-<li>Other findings (<a title="lung nodule" href="/articles/pulmonary-nodule">lung nodule</a>). </li>~~
+<li>Extra-coronary calcification (aortic valve or wall calcification, <a href="/articles/mitral-valve-calcification">mitral valve calcification</a>)</li>
+<li>Other findings (<a href="/articles/pulmonary-nodule">lung nodule</a>). </li>
~~-<li><a title="Coronary Artery Disease - Reporting and Data System" href="/articles/coronary-artery-disease-reporting-and-data-system-3">Coronary Artery Disease - Reporting and Data System</a></li>~~
+<li><a href="/articles/coronary-artery-disease-reporting-and-data-system-3">Coronary Artery Disease - Reporting and Data System</a></li>

References changed:

1. Hecht HS, Cronin P, Blaha MJ, Budoff MJ, Kazerooni EA, Narula J, Yankelevitz D, Abbara S. 2016 SCCT/STR guidelines for coronary artery calcium scoring of non-contrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Cardiovasc Comput Tomogr. 2017;11:74–84.

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