Fig. 3

CT images obtained from a 79-year-old man with pancreatic ductal adenocarcinoma in the pancreas head. A Arterial phase axial contrast enhanced CT image (window width, 400HU; window level, 40HU) acquired through the standard protocol showed a 1.5 cm hypo-attenuating lesion in the pancreas head (arrow) abutting the SMV. The calculated CNR of pancreatic tumor was 7.4. B Arterial phase axial contrast enhanced CT image (window width, 400HU; window level, 40HU) acquired through the high-resolution protocol also revealed a 1.5 cm hypo-attenuating lesion (arrow) with calculated CNR of pancreatic tumor of 15.7. The abutment of SMV was also noted. Upon reviewing these imaging findings, all three readers classified this patient as having resectable pancreatic ductal adenocarcinoma on both CT protocols. Nevertheless, surgical exploration unveiled unexpected peritoneal seeding, making the tumor unresectable