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Purpose: An investigation of coronary computed tomography angiography (CCTA)-derived quantitative parameters to determine CAD-RADS 4 versus CAD-RADS 3 of coronary lesions with moderate to severe calcification. Material and methods: The study included 150 coronary lesions proven to have moderate or severe stenosis by invasive coronary angiography and showing moderate to severe calcification in CCTA. Various CCTA-quantitative parameters were correlated to the degree of stenosis (moderately versus severely stenosed lesions). Their sensitivity and specificity to detect severe stenosis (supposed to be corresponding to CAD-RADS 4) were examined at multiple cut-off points. Results: The calcification remodelling index (CRI) was the only statistically significant independent computed tomography angiography-derived predictor of severe stenosis versus moderate stenosis on multivariate regression analysis. The best cut-off value was ≤ 0.84, with 77.78% sensitivity and 86.46% specificity. Conclusions: From all quantitative-derived CCTA parameters, CRI ≤ 0.84 was the predictor with the highest diagnostic performance for severe versus moderate stenosis in moderately to severely calcified coronary lesions. Accordingly, CRI can help to determine CAD-RADS 4 versus CAD-RADS 3. [ABSTRACT FROM AUTHOR]