"Carotid Plaque-RADS (Reporting and Data System) is a standardised, multimodality classification system for the assessment and reporting of extracranial carotid atherosclerotic plaque morphology and composition 1."
"The Plaque-RADS system is designed to complement, but not replace, stenosis grading. It serves several purposes:"
"Plaque-RADS scores range from grade 1 to 4 and increase in severity based on maximum wall thickness and the presence of complicated features."
"Plaque-RADS 1"
"Plaque-RADS 2"
"Plaque-RADS 3"
"Plaque-RADS 3a"
"Plaque-RADS 3b"
"Plaque-RADS 3c"
"Plaque-RADS 4"
"Plaque-RADS 4a: intraplaque haemorrhage"
"Plaque-RADS 4b: ruptured fibrous cap"
"Plaque-RADS 4c: intraluminal thrombus"
"The Plaque-RADS categories may be supplemented by optional ancillary features that do not determine the main score but provide complementary vulnerability information 1:"
"[side of carotid]: [stenosis degree using NASCET protocol] / modality and Plaque-RADS score / MWT / ancillary features / modifiers"
"[side of carotid]: [stenosis degree using NASCET protocol] / modality and Plaque-RADS score / MWT / ancillary features / modifiers"
"Right carotid: NASCET 50% / MRI Plaque-RADS 4a / MWT 5 mm / positive remodelling"
"Right carotid: NASCET 50% / MRI Plaque-RADS 4a / MWT 5 mm / positive remodelling"
"CTA-based assessment using the Carotid Plaque-RADS has a significant learning curve, but intermediate and experienced readers have substantial to nearly perfect inter- and intrareader agreement 3. An MRI-specific interrater reliability study for Carotid Plaque-RADS remains to be published."
"CTA-based assessment using the Carotid Plaque-RADS has a significant learning curve, but intermediate and experienced readers have substantial to nearly perfect inter- and intrareader agreement 3. An MRI-specific interrater reliability study for Carotid Plaque-RADS remains to be published."
"The validity of Plaque-RADS is supported by MRI-based studies of individual features. A meta-analysis on the prediction of recurrent stroke or transient ischaemic attack found lipid-rich necrotic core had a hazard ratio of 2.73 (95% CI: 1.04-7.16), thinning/rupture of the fibrous cap had a hazard ratio of 5.68 (95% CI: 2.40-13.47), and intraplaque haemorrhage had a hazard ratio of 7.14 (95% CI: 4.32-11.82) 4."
"CTA-based Plaque-RADS has been validated for predicting first or recurrent stroke, showing a monotonic increase in the odds of symptomatic status even after adjustment for stenosis degree and clinical covariates 2. The highest grade, Plaque-RADS 4c (intraluminal thrombus) was the strongest predictor (adjusted odds ratio 17.9, 95% CI: 6.1-52.4) 2."
"CTA-based Plaque-RADS has been validated for predicting first or recurrent stroke, showing a monotonic increase in the odds of symptomatic status even after adjustment for stenosis degree and clinical covariates 2. The highest grade, Plaque-RADS 4c (intraluminal thrombus) was the strongest predictor (adjusted odds ratio 17.9, 95% CI: 6.1-52.4) 2."
"Subcategorizations may be made depending on imaging technique. In particular, MRI is the preferred modality for determining the fibrous cap status (thick plaque with thick or thin cap is graded 3a vs. 3b; healed ulcerated or recently ruptured plaque is graded 3c vs. 4b). CTA is not suitable for fibrous cap assessment (thick plaque is graded 3; ulcerated plaque is graded is 3c)."
"Subcategorizations may be made depending on imaging technique. In particular, MRI is the preferred modality for determining the fibrous cap status (thick plaque with thick or thin cap is graded 3a vs. 3b; healed ulcerated or recently ruptured plaque is graded 3c vs. 4b). CTA is not suitable for fibrous cap assessment (thick plaque is graded 3; ulcerated plaque is graded is 3c)."
"L: limited diagnostic study (e.g. blooming artifacts on CT, motion or metal artifacts)"
"Right carotid: NASCET 50% / MRI Plaque-RADS 4a / MWT 5 mm / positive remodelling"
Expected headings
"Classification"
"Plaque-RADS 1"
"Plaque-RADS 2"
"Plaque-RADS 3"
"Plaque-RADS 3a"
"Plaque-RADS 3b"
"Plaque-RADS 3c"
"Plaque-RADS 4"
"Plaque-RADS 4a: intraplaque haemorrhage"
"Plaque-RADS 4b: ruptured fibrous cap"
"Plaque-RADS 4c: intraluminal thrombus"
"Ancillary features"
"Modifiers"
"Performance"
"Plaques in this category may consist of fibrous tissue, a small lipid pool or lipid-rich necrotic core, and calcifications, but no complicated plaque features (i.e. no intraplaque haemorrhage, fibrous cap rupture, or intraluminal thrombus). On all modalities, there is eccentric wall thickening"
"Plaques in this category may consist of fibrous tissue, a moderate-to-large lipid-rich necrotic core, calcifications, and/or healed ulceration, but no complicated plaque features (i.e. no intraplaque haemorrhage, fibrous cap rupture, or intraluminal thrombus)."
"Subcategorizations may be made depending on imaging technique. In particular, MRI is the preferred modality for determining the fibrous cap status (thick plaque with thick or thin cap is graded 3a vs. 3b; healed ulcerated or recently ruptured plaque is graded 3c vs. 4b). CTA is not suitable for fibrous cap assessment (thick plaque is graded 3; ulcerated plaque is graded is 3c)."
"Subcategorizations may be made depending on imaging technique. In particular, MRI is the preferred modality for determining the fibrous cap status (thick plaque with thick or thin cap is graded 3a vs. 3b; healed ulcerated or recently ruptured plaque is graded 3c vs. 4b). CTA is not suitable for fibrous cap assessment (thick plaque is graded 3; ulcerated plaque is graded is 3c)."
"On MRI, there is an ulceration with visible disruption of the fibrous cap (discontinuity of the band between lumen and lipid-rich necrotic core). There is usually associated intraplaque haemorrhage. CTA is not able to identify this feature."
"L: limited diagnostic study (e.g. blooming artifacts on CT, motion or metal artifacts)"