Abstract
Acute pancreatitis (AP), a prevalent acute abdominal emergency, frequently leads to severe complications such as pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. These complications can progress to systemic inflammation and multiple organ failure, significantly prolonging hospitalization and markedly increasing mortality. Computed tomography (CT) and magnetic resonance imaging (MRI) are nowadays indispensable in the detection and evaluation of AP complications, and each technique has its own advantages: CT, being widely available and rapid, excels at initial severity stratification and gas-containing necrosis identification; conversely, MRI, leveraging superior soft-tissue contrast and avoiding ionizing radiation, is ideal for serial monitoring - particularly in characterizing complex fluid collections (distinguishing walled-off necrosis from pancreatic pseudocysts) and detecting microlithiasis. However, the existing literature lacks systematic comparisons between CT and MRI across the full spectrum of AP complications, encompassing their imaging characteristics, clinical utility, sensitivity, and specificity. To address this gap, this review comprehensively synthesizes the diagnostic roles, efficacy, and limitations of both modalities for different AP complication types. Furthermore, it proposes novel insights for future advancements, such as AI-assisted diagnosis, multimodal complementary approaches, diffusion imaging, and other technologies, aiming to provide a contemporary perspective to inform clinical decision-making, optimize imaging pathways, and ultimately improve patient outcomes.