{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T21:24:49Z","timestamp":1791408289465,"version":"4.3.3"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T00:00:00Z","timestamp":1744329600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the image quality, radiation dose, and examination time between non-electrocardiogram (ECG)-gated coronary CT angiography (ECG-less CCTA) and conventional ECG-gated CCTA using wide-detector CT, and validate its clinical applicability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this prospective study, 109 patients with suspected coronary artery disease were divided into ECG-less (Group A, <jats:italic>n<\/jats:italic>\u2009=\u200959) and ECG-gated (Group B, <jats:italic>n<\/jats:italic>\u2009=\u200950) groups. Objective metrics (CT attenuation, noise, SNR, CNR), subjective image quality (4-point scale), and examination time were analyzed. Diagnostic performance (sensitivity, specificity) was evaluated against invasive coronary angiography (ICA). A modified ECG-less protocol (Group A2, <jats:italic>n<\/jats:italic>\u2009=\u200930) was implemented to optimize radiation dose. Plaque characterization agreement was assessed using Cohen\u2019s <jats:italic>\u03ba<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The ECG-less group demonstrated higher radiation dose (2.83\u2009\u00b1\u20090.93 vs. 1.90\u2009\u00b1\u20091.41\u2005mSv, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) but significantly shorter examination time (225.03\u2009\u00b1\u200933.37 vs. 330.06\u2009\u00b1\u200956.35\u2005s, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). The modified ECG-less protocol reduced the effective dose by 28% (2.03\u2009\u00b1\u20090.75\u2005mSv, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001 vs. Group A), achieving statistical comparability to the conventional group (<jats:italic>p<\/jats:italic>\u2009=\u20090.62). Subjective image scores (4-point scale) and SNR\/CNR showed no significant differences between groups (<jats:italic>p<\/jats:italic>\u2009&amp;gt;\u20090.05). ECG-less CCTA achieved per-segment sensitivity\/specificity of 93.3%\/97.5% and per-patient 94.4%\/50% for detecting \u226550% stenosis. Plaque characterization exhibited high agreement (calcified: <jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.82; non-calcified: <jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.78; mixed: <jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.75).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ECG-less CCTA provides comparable image quality and diagnostic accuracy to conventional ECG-gated CCTA while significantly reducing examination time. This technique is applicable in emergency scenarios where ECG lead placement is unfeasible (e.g., severe trauma, unreliable ECG signals).<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1570743","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T05:14:04Z","timestamp":1744348444000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Comparing image quality of coronary CT angiography with and without ECG-gating in wide-detector 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