Wang Kun, Zhang Yueqiao, Chen Bin, Ren Hong
Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Cardiovasc Med. 2025 Apr 11;12:1570743. doi: 10.3389/fcvm.2025.1570743. eCollection 2025.
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.
In this prospective study, 109 patients with suspected coronary artery disease were divided into ECG-less (Group A, = 59) and ECG-gated (Group B, = 50) 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, = 30) was implemented to optimize radiation dose. Plaque characterization agreement was assessed using Cohen's .
The ECG-less group demonstrated higher radiation dose (2.83 ± 0.93 vs. 1.90 ± 1.41 mSv, < 0.001) but significantly shorter examination time (225.03 ± 33.37 vs. 330.06 ± 56.35 s, < 0.001). The modified ECG-less protocol reduced the effective dose by 28% (2.03 ± 0.75 mSv, < 0.001 vs. Group A), achieving statistical comparability to the conventional group ( = 0.62). Subjective image scores (4-point scale) and SNR/CNR showed no significant differences between groups ( > 0.05). ECG-less CCTA achieved per-segment sensitivity/specificity of 93.3%/97.5% and per-patient 94.4%/50% for detecting ≥50% stenosis. Plaque characterization exhibited high agreement (calcified: = 0.82; non-calcified: = 0.78; mixed: = 0.75).
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).
比较使用宽探测器CT的非心电图（ECG）门控冠状动脉CT血管造影（无ECG的CCTA）与传统ECG门控CCTA的图像质量、辐射剂量和检查时间，并验证其临床适用性。
在这项前瞻性研究中，109例疑似冠心病患者被分为无ECG组（A组，n = 59）和ECG门控组（B组，n = 50）。分析客观指标（CT衰减、噪声、SNR、CNR）、主观图像质量（4分制）和检查时间。对照有创冠状动脉造影（ICA）评估诊断性能（敏感性、特异性）。实施改良的无ECG方案（A2组，n = 30）以优化辐射剂量。使用科恩kappa系数评估斑块特征一致性。
无ECG组的辐射剂量更高（2.83±0.93 vs. 1.90±1.41 mSv，P < 0.001），但检查时间显著更短（225.03±33.37 vs. 330.06±56.35 s，P < 0.001）。改良的无ECG方案使有效剂量降低了28%（2.03±0.75 mSv，与A组相比P < 0.001），与传统组达到统计学可比性（P = 0.62）。主观图像评分（4分制）和SNR/CNR在组间无显著差异（P > 0.05）。无ECG的CCTA检测≥50%狭窄时，节段敏感性/特异性为93.3%/97.5%，患者敏感性/特异性为94.4%/50%。斑块特征表现出高度一致性（钙化：κ = 0.82；非钙化：κ = 0.78；混合：κ = 0.75）。
无ECG的CCTA与传统ECG门控CCTA相比，提供了相当的图像质量和诊断准确性，同时显著缩短了检查时间。该技术适用于无法进行ECG导联放置的紧急情况（如严重创伤、不可靠的ECG信号）。
