MRI/MRCP and EUS in pancreatobiliary disease: complementary roles and a proposed imaging pathway

This review defines complementary roles of MRI/MRCP and endoscopic ultrasound (EUS) in pancreatobiliary disease. EUS is problem-solving when MRI is equivocal, enabling tissue acquisition, molecular testing, and interventions. A clinically driven selective imaging pathway is prop…

• MRI/MRCP provides comprehensive noninvasive assessment and is foundational; EUS is reserved for unresolved questions where its result may change management.
• The review addresses small solid lesions, pancreatic cysts, microlithiasis, autoimmune pancreatitis mimics, and therapeutic EUS applications.
• Limitations of EUS in altered anatomy, gastric outlet obstruction, pancreatic tail lesions, and multifocal neuroendocrine tumors are discussed.

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