Objective To analyze the MRI imaging features and diagnostic value of cesarean scar pregnancy (CSP). Methods The clinical data of 37 patients with CSP admitted to our hospital were collected retrospectively. All patients were diagnosed with surgical pathology and were given MRI examination. The MRI imaging features were analyzed, and the diagnostic value was explored. Results The gestational sac of 37 CSP patients were located in the lower part of anterior uterine wall, and the gestational sac of 23 patients was a simple cystic structure, and T1WI, T2WI, and fat suppression T2WI showed low signal, high signal and high signal respectively. A total of 14 cases of gestational sac showed mixed signals with unclear muscular boundary, and there was slightly low or equal signal in T1WI, low or high signal in T2WI and low or high signal in fat suppression T2WI. There were 15 cases with endogenous CSP and 22 cases with exogenous CSP. The thinnest scar thickness and the gestational sac volume of endogenous CSP were (4.49±1.71)mm and (86.25±31.48)cm3 respectively, which were greater than those of exogenous CSP with (2.28±1.03)mm and (63.91±28.05)cm3 (P<0.05). There was no significant difference in gestational sac type compared with exogenous CSP (P>0.05) The contact area between gestational sac and scar and the rich ratio of blood supply around gestational sac were (3.17±0.96)cm2 and 26.67% respectively, which were lower than those of exogenous CSP with (4.05±1.12)cm2 and 72.73% (P<0.05). Based on the results of surgical pathology, the diagnostic accuracy of MRI for CSP was 89.19%. Conclusion MRI scan can show the CSP imaging features, and there were significant differences in the thinnest scar thickness, the gestational sac volume and the rich blood supply around the gestational sac between the endogenous and exogenous gestational sacs, and the diagnostic accuracy can be improved according to relevant features.