A 65-year-old man with unresectable adenocarcinoma of the body of the pancreas which encases and occludes the portal vein/SMV confluence, and encases the SMA and celiac axis, treated with FOLFIRINOX switched to gemcitabine/abraxane due to poor tolerance. Tumor diameter increased to 117% of the baseline, tumor volume 184%, and CA19–9 540% after chemotherapy. Peritoneal carcinomatosis with ascites developed on post-chemotherapy CT. A Baseline arterial and B venous phase CT. C Post-chemotherapy arterial and D venous phase CT. Tumor iodine uptake and normalized tumor iodine uptake were A 1.0 mg/mL and 9%, B 1.5 mg/mL and 41%, C 1.2 mg/mL and 8%, and D 2.4 mg/mL and 38%.