Objective To explore the MRI findings of cesarean scar pregnancy (CSP) and their guiding significance for the treatment. Methods The clinical data of 32 patients with CSP confirmed by operation were analyzed retrospectively. The MRI findings were analyzed, and the characteristics of operation were analyzed according to the imaging findings. Results ①MRI images of the 32 cases showed clear gestation sac, and the uterine isthmus showed slightly long T1 and slightly short T2 signal (caesarean scar), with unobvious enhancement. ②MRI of pregnant women with intact gestation sac showed T1 or slightly longer T1 and long T2 annular signal. The contents of the sac showed long T1 and long T2 signal with strong capsule signal on T2WI. Images of those with incomplete gestation sac showed slightly longer T1 signal, slightly longer, equal or slightly shorter T2 signal. ③There were 8 cases with gestation sac complete implanted in uterine myometrium. The uterus was C-shaped or anti-3 shaped. The gestation sacs of 24 cases showed intrauterine growth trend, the myometrium was involved and the implanted uterine wall was shallow, with clear boundary with the muscle layer. ④Patients were treated by laparoscopic CSP electrocision according to the condition of the gestation sac implantation and the thinnest wall of the uterus. Conclusion MRI findings of patients with CSP are specific, which can provide reference for the treatment of CSP.