Objective To investigate the clinical value of CT and MRI in reflecting abdominal wall involvement in patients with severe acute pancreatitis. Methods Seventy cases with severe acute pancreatitis were enrolled in the study. The results of ultrasound examination showed highly suspicious abdominal wall involvement.All subjects successively underwent CT and MRI examination, and the imaging data were complete. The detection rates of abdominal wall involvement were compared between CT and MRI, and the findings of CT and MRI of abdominal wall involvement in severe acute pancreatitis were analyzed. Results CT scan found 37 cases with abnormal abdominal wall density, and the detection rate of abdominal wall involvement was 52.86% while MRI scan found 40 cases with abnormal abdominal wall signal, and the detection rate of abdominal wall involvement was 57.14%. Among 70 cases, a total of 46 cases (65.71%) with abdominal wall involvement were detected by CT and MRI, and the detection rate showed no significant difference between CT and MRI (P＞0.05). CT and MRI showed that the sites of abnormal abdominal wall included unilateral and bilateral abdominal wall, and abnormal unilateral abdominal wall was common. CT scan showed increased abdominal fat layer density, blurred boundaries of muscle-fat gap and muscle tissue density lower than thedensity of the same layer without involvement. MRI scan showed that the abdominal wall fat layer showed slightly lower T1WI and T2WI fat suppression sequence high signal, increased densityand blurred boundaries of muscle-muscle gap, with presence of spot-like, line and patchy T1WI slightly lower, T2WI fat suppression sequenceirregular high signal shadow. CT and MRI enhanced scans showed patchy, linear and patchy mild to moderate enhancement. Conclusion Both CT and MRI can reflect abdominal wall involvement in patients with severe acute pancreatitis, and the imaging findings are characteristic. The detection rate of MRI for abdominal wall involvement is relatively higher, and it can be used combined with CT for detection of abdominal wall involvement.