OBJECTIVE: Solid pseudopapillary tumor of the pancreas is a rare lesion of the pancreas and is a junctional tumor with a good prognosis after surgical resection, although it has a potential malignant tendency. A clear preoperative diagnosis is important for appropriate therapeutic measures. The purpose of this article is to describe the clinical and MDCT manifestations of solid pseudopapillary tumor of the pancreas and to explore the diagnostic value of MDCT. MATERIALS AND METHODS: Thirty-nine cases of solid pseudopapillary tumor of pancreas confirmed by surgical pathology, clinical data were collected, and MDCT plain and enhanced scans (arterial and venous phase) were performed in all cases to analyze the CT manifestations of all the cases and to compare with the pathology. RESULTS: Thirty-nine cases of solid pseudopapillary tumors of the pancreas were found, ranging from 15 to 64 years old (mean age 33 years old), of which 28 were females and 11 were males. Clinically, there were no specific symptoms and they presented only with abdominal pain. The tumors originated from the pancreas, were round and oval in shape, most of them had a complete envelope, and most of them were clearly demarcated from the pancreas. The tumors were located in the neck of the pancreatic head in 20 cases (including 3 cases of leptomeninges) and in the tail of the body in 19 cases. The maximum diameter of the tumors ranged from 2 cm to 17 cm, with an average of 7.5 cm, and the size was not related to the benign or malignant nature. The tumor could be manifested as a homogeneous solid mass or a cystic solid or cystic mass, and the solid structure was low or slightly isodense on CT plain scanning, with mild enhancement in arterial phase, which contrasted with the surrounding pancreatic tissues that were obviously enhanced; and obvious enhancement in portal venous phase, which was sometimes similar to the enhancement of normal pancreas so that there was a reduction in the extent of the lesion. The cystic portion is hypointense on both pre- and post-enhancement scans. The cysts may be separated from each other and there is enhancement of the separation. Calcification can be seen within the tumor, which is often patchy and characteristic; sometimes the peritoneum and septa can be calcified and resemble eggshells. The vast majority of tumors are not associated with dilatation of the common bile duct and pancreatic duct or atrophy of the pancreas distal to the tumor. The huge tumor pushes against the surrounding structures, and the junctional or malignant ones are poorly demarcated from the surrounding structures. CONCLUSION: Pancreatic solid-pseudopapillary tumors are prevalent in young women, with no specific clinical symptoms. CT shows cystic solid masses, often large, with clear borders, progressive enhancement of the solid portion and peritoneum, sometimes with calcification, and most of them are not accompanied by dilatation of the pancreatic ducts or bile ducts, which has certain characteristics. MDCT has important diagnostic value, and needs to be compared with mucinous or plasmacytoid cystadenomas, cystic adenocarcinoma, pancreatic adenocarcinoma, cystic change, pancreatic pseudopapillary tumor, and pancreatic pseudopapillary tumor. It should be differentiated from mucinous or plasma cystadenoma, cystic adenocarcinoma, pancreatic adenocarcinoma, cystic change, pancreatic pseudocyst, etc.