One-Stop multienergy pancreatic dynamic volume perfusion imaging using photon-counting detector CT: Initial experience

Purpose: This study reports initial experience with a modified one-stop, multienergy pancreatic VPCT protocol using PCCT, designed for comprehensive morphologic analysis and functional perfusion assessment of pancreatic ductal adenocarcinoma (PDAC). Materials and Methods: From April 2024 to October 2024, participants with suspected PDAC were prospectively enrolled and underwent preoperative pancreatic dynamic VPCT. Individual phase images were extracted from perfusion datasets using T3D, virtual monoenergetic images (VMIs) at 55 and 70 keV reconstruction for diagnostic interpretation. Diagnostic image quality was assessed both quantitatively and subjectively. Perfusion maps were generated for analysis. Perfusion parameters were compared between PDAC lesions and normal parenchyma, as well as among PDAC histopathological differentiation. Radiation doses were recorded. Results: A total of 65 participants (39 male; mean age, 66.2 +/- 6.3 years) with histologically confirmed PDAC were included. The protocol achieved a mean effective radiation dose of 16.4 +/- 4.5 mSv. All individual phase images met diagnostic quality standards (subjective scores >= 3). Among these, 55 keV VMIs demonstrated the highest CNR for PDAC lesions and adjacent vasculature, and superior subjective scores for lesion conspicuity in both pancreatic parenchymal and portal venous phases (all p < 0.05). Perfusion parameters, including blood flow (BF), blood volume (BV), time to drain (TTD), mean transit time, time to start, Tmax, and flow extraction product (FEP), differed significantly between PDAC lesions and normal parenchyma (all p < 0.05). Poorly differentiated PDAC lesions exhibited significantly lower BF, BV, TTD, and Tmax values and reduced lesion-to-parenchyma ratios of BF, BV, and FEP compared to moderately-to-well-differentiated PDAC lesions. Conclusion: The one-stop, multienergy pancreatic VPCT protocol using PCCT enables high-quality morphologic imaging and reliable functional perfusion assessment at reduced radiation doses. It provides valuable insights into PDAC differentiation and histopathological grading, with potential implications for improved clinical management.