Photon-counting CT for pancreatic cancer: advancing precision imaging and virtual surgical navigation

Pancreatic cancer remains highly lethal, with a 5-year survival below 15%. While surgical resection is the only potentially curative approach, conventional imaging often fails to clearly delineate tumor boundaries and adjacent anatomy, compromising preoperative planning and surgical precision. This review summarizes recent advancements in photon-counting computed tomography (PCCT) for pancreatic cancer imaging and surgical planning. A literature search was conducted to identify relevant studies published between 2018 and 2025, focusing on PCCT's role in tumor visualization, comprehensive vascular mapping including invasion and anatomical variants, lymph node detection, and surgical navigation. PCCT provides ultra-high spatial resolution and intrinsic spectral imaging capabilities, significantly improving the visualization of low-contrast pancreatic tumors and subtle anatomical details. Emerging preliminary clinical evidence highlights PCCT's potential to enhance diagnostic accuracy, precisely assess tumor resectability, and guide surgical interventions. As clinical adoption expands, PCCT may become a key imaging tool for precision management of pancreatic cancer.