CT
What would be the CAD-RADS category for this case - according to the new CAD-RADS 2.0?
CAD-RADS 3/P4 or CAD-RADS 3/P4/N (if less confident or only assessed in the standard algorithm)
What would you recommend in this case?
The patient should have a stress test to look for myocardial ischaemia. He should also receive aggressive risk factor modification, preventive therapy, and other treatments, including anti-anginal therapy as per guidelines.
Technique
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image reconstruction without edge correction and without motion correction
Findings
Without edge correction, the transition of the three sequential axial steps can be identified clearly as a sharp edge, visible in the coronal and sagittal multiplanar and 3D reconstructions.
The odd-looking plaque in the proximal third of the right coronary artery with possible high-risk features looks much less conspicuous in this image reconstruction. It is consistent with an artifact in the standard reconstruction mode. The plaque-related stenosis in the middle segment of the right coronary artery can now be better assessed in the area of the transition zone and rated as moderate stenosis.
In the standard algorithm with 'edge correction', it looks rather blurry.