Photon-counting detector computed tomography: iodine density versus virtual monoenergetic imaging of pancreatic ductal adenocarcinoma

Pancreatic carcinoma has a poor prognosis and is the seventh leading cause of cancer-associated deaths worldwide [ 1 ]. The most common primary pancreatic carcinoma is pancreatic ductal adenocarcinoma (PDAC) [ 2 ]. Computed tomography (CT) is the workhorse for the evaluation of local invasion of pancreatic tumors and assessment of resectability [ 3 ]. A typical CT pancreas protocol is a dual phase acquisition comprising a late arterial phase (LAP), also known as pancreatic phase, 35–40 s after contrast injection and a portal venous phase (PVP) at around 70 s [ 4 ]. The LAP offers a greater attenuation difference between the enhancing pancreatic parenchyma and the hypoattenuating PDAC [ 5 ]. However, a LAP is not always available, such as during an initial CT scan of the patient or during a follow-up CT in patients with metastatic disease when the examination is performed only in the PVP.