Background & Aims Pancreatic neuroendocrine tumors (pNETs) are rare epithelial-origin tumors arising from pancreatic islet endocrine cells with malignant potential. Some tumors secrete excessive hormones, leading to specific endocrine syndromes. This study was performed to analyze the clinical characteristics, basic features of CT and endoscopic ultrasonography (EUS), and the correlation between various clinical features and prognosis of pNETs to provide clinical reference.Methods The clinical data of 111 patients with pNETs treated in Xiangya Hospital, Central South University, from January 1, 2016, to May 1, 2023, were reviewed. All patients were pathologically confirmed through surgical resection or biopsy. The general information, laboratory indexes, and imaging data of patients were collected. The clinical characteristics, pathological grade, imaging features of pNETs, and risk factors related to prognosis were analyzed.Results Among the 111 diagnosed pNETs patients, there were 53 males (47.7%) and 58 females (52.3%), with a mean age of (50.54±13.38) years. There were 61 cases (55.0%) of non-functional pNETs (NF-pNETs) and 50 cases (45.0%) of functional pNETs (F-pNETs). Analysis of clinical characteristics revealed that patients in the advanced stage (Ⅲ/Ⅳ) had higher pathological grades, and tumors mostly non-functional, manifesting predominantly through symptoms related to compression or metastasis, higher positivity for neuron-specific enolase (NSE), and non-surgical treatment, such as chemotherapy and biologics, predominated in cases with metastasis. According to the pathological grades, CT feature analysis revealed that, compared to the low-grade group (G1/G2), the high-grade group (G3/NEC) had irregular tumor shapes, unclear borders, and were more prone to lymph node metastasis and distant metastasis (all P<0.05); EUS feature analysis showed that patients in the high-grade group had a greater tumor longitudinal diameter compared to the low-grade group (P<0.05). The median follow-up time was 37 months, with a follow-up rate of 78.37%. A total of 87 cases were included in the analysis of prognosis-related factors, and the results showed that treatment method (surgery vs. non-surgery: HR=0.232, 95% CI=0.056-0.969, P=0.045), lesion morphology (irregular vs. regular: HR=7.038, 95% CI=2.028-24.427, P=0.002), and NSE (positive vs. negative: HR=3.584, 95% CI=1.029-12.481, P=0.045) were independent risk factors for prognosis of patients.Conclusion Surgery is the preferred treatment for pNETs, with a higher surgical rate for F-pNETs than NF-pNETs. CT and EUS-guided fine-needle aspiration/biopsy (EUS-FNA) are sensitive and accurate methods for diagnosing pNETs. Lesion morphology, treatment method, and NSE have the potential to predict clinical prognosis in patients. Therefore, analyzing the clinical characteristics and imaging features of pNETs is helpful for comprehensive disease assessment, monitoring disease progression, making appropriate diagnosis and treatment plans, and improving prognosis.