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Unlike conventional energy-integrating detector CT, PCD-CT directly converts X-ray photons into electrical signals, allowing inherent spectral imaging, improved spatial resolution, and enhanced dose efficiency. These characteristics enable flexible retrospective reconstruction, including virtual monoenergetic imaging and material decomposition, which can be tailored to specific clinical tasks and applications. These capabilities translate into meaningful clinical benefits in abdominal radiology. Low-keV imaging improves lesion conspicuity, facilitating the detection of subtle findings including early-stage pancreatic cancer, small metastases, and inflammatory changes. Further, spectral imaging improves tissue characterization, enabling differentiation between true and pseudoenhancement and supporting more accurate staging in oncologic imaging. Moreover, amplifying iodine contrast may enable substantial contrast dose reduction while maintaining diagnostic quality, potentially benefiting selected patients who require contrast optimization. PCD-CT may support the concept of \u201cone-stop imaging\u201d by providing both systemic and local diagnostic information within a single examination, potentially reducing the need for additional imaging in selected clinical scenarios. Quantitative imaging approaches, including iodine density mapping and extracellular volume assessment, provide functional information that may serve as imaging biomarkers for disease activity and treatment response. Emerging applications, including virtual noncalcium imaging, expand the role of CT into domains traditionally reserved for magnetic resonance imaging. Challenges including increased data volume, technical limitations, cost-effectiveness, and the need for optimized reconstruction strategies, remain despite these advantages. 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