To analyze the imaging and clinical manifestations of solid-pseudopapillary neoplasms of the pancreas (SPNP), and to explore the predictive value of CT and MRI for benign and malignant SPNP.

From January 2010 to December 2017, sixty patients with pathologically proved SPNP were collected from Sun Yat-sen Memorial Hospital. The patients’ clinical and imaging data were analyzed retrospectively with χ² test and logistic regression.

Fifty-one cases (85.0%) were young women with an average age of 34.5 years. Thirty-three patients (55.0%) had non-specific clinical symptoms and tumor markers were negative in 54 patients (90.0%). All the 60 patients had underwent surgery for treatment, with the incidence of postoperative complications higher in patients with tumor capsular defect (44.1%) than tumor capsular intact (19.2%) (χ²=4.106, P=0.043), and lower in patients under laparoscopic surgery (10.5%) than laparotomy (43.9%) (χ²=5.508, P=0.011). SPNP always occurred in the tail (60.0%), and most of them (61.7%) had regular shape with an average diameter of 5.7 cm. There were capsules with the tumors, which showed up as ring low signal on MRI and enhanced obviously. Most of the tumors were cystic mass (56.7%) and the density or signal was heterogeneous (83.3%), for peripheral calcification (21.7%) and hemorrhage (30.0%) could be found, and in all the cases, CT and MRI enhanced scans appeared as progressive and inhomogeneous. Clinical and CT imaging features including age, tumor size, shape, and tumor capsular defect in benign and malignant SPNP had statistical significance (P=0.047, 0.029, 0.049, <0.001), while none of the above factors were independent risk factors by multivariate logistic regression.

SPNP is commonly seen in young females with no specific clinical symptoms. CT and MRI demonstrate characteristic features of SPNP, and have great value in differential diagnosis between malignant and benign SPNP. Surgery is effective for SPNP, and laparoscopic surgery can be the first choice for good prognosis.