Objective To analyze the magnetic resonance imaging (MRI) image features and clinical outcomes of patients with cesarean scar pregnancy (CSP). Methods The clinical data of 34 patients with CSP who were admitted to the hospital from January 2015 to June2017 were retrospectively analyzed, and their MRI image features were analyzed. The image features and clinical outcomes of different types of CSP were compared. Results The MRI image characteristic of CSP was that the pregnancy matter was planted at the scar of the anterior wall of the uterus. There were 13 cases of cystic gestational sacs. MRI showed low signal on T1WI and high signal on T2WI, and enhanced scan showed circular thin-walled enhancement. There were 21 cases of massive gestational sacs. MRI showed low signal on T1WI and mixed signal on T2WI, and enhanced scan showed ring-shaped thick-wall enhancement. The minimum thickness of scar at implantation site was (3.61±1.12) mm, the length of pregnancy sac and scar intersection was (19.46±9.74) mm, and the size of gestational sac was (643.36±197.65) mm2 . The blood supply was rich in 20 cases and lacking in 14 cases. There were 20 cases of exogenic type and 14 cases of endogenous type. Compared with endophytic type, exogenic type had smaller scar thickness and gestational sac area, larger intersect length of gestational sac and scar (P<0.05), and the proportion of rich peripheral blood supply of gestational sac was relatively higher (P<0.05). Compared with the endogenous type, the proportion of uterine artery chemoembolization for exogenic type and the bleeding volume in uterus curettage were higher/more, and the negative conversion time of β-HCGwas longer(P<0.05). Conclusion The MRI image features of CSP are characteristic, and there are differences between extrinsic and endogenous image features and clinical outcomes. MRI examination is of great guiding significance for clinical treatment.