〔Abstract〕 To investigate the clinical characteristics and risk factors of Mycoplasma pneumoniae pneu- monia（MPP）in children based on a dual classification integrating imaging features and clinical severity. Meth ⁃ ods Medical records of 2 054 pediatric patients with MPP were retrospectively analyzed. The cohort was stratified into severe consolidation（n=253）， severe non-consolidation（n=118）， non-severe consolidation（n=393）， and non-severe non-consolidation groups（n=1 290）based on clinical and radiological findings. Inter group data and characteristics were compared and multiple regression analysis was conducted to construct a prediction model for se - vere consolidation group. Results Significant differences were observed among the groups in terms of age，dura-tion of fever ，length of hospital stay ，presence of pulmonary rales ，inflammatory markers［C-reactive protein （CRP）and lactate dehydrogenase（LDH）］， the use of hormones，and bronchoscopic treatment（all P < 0. 05）. Compared with the severe non-consolidation group ， non-severe consolidation group ， and non-severe non- consolidation group，children in severe consolidation group exhibited the longest duration of fever［8（6，11）days vs 6（2，9），7（6，9）and 6（3，8）days，respectively］and the longest length of hospital stay［7（5，8）days vs 6 （5，8），6（5，8）and 6（4，7）days，respectively］. They also had the highest incidence of reduced breath sounds ［34 cases（13. 4%）vs 2 cases（1. 7%）， 29 cases（7. 4%）and 13 cases（1. 0%）， respectively］and a substan-tially higher rate of coinfections，particularly viral infections［63 cases（24. 9%）vs 23 cases（19. 5%），60 cases （15. 3%）and 190 cases（14. 7%），respectively］. Multivariate analysis indicated that the independent risk factors for severe MPP（ SMPP ）were age > 4. 5 years，length of hospital stay > 6. 5 days，reduced breath sounds， neutrophil-to-lymphocyte ratio（NLR ）> 1. 66，LDH > 370. 5 U/L，CRP > 9. 5 mg/L，and coinfection with vi-ruses. Reduced breath sounds（OR = 5. 58，95% CI：2. 45 - 12. 69）and coinfection with bacteria（OR = 3. 11， 95% CI：1. 43 - 6. 75）were identified as the most significant risk factors for pulmonary consolidation in non-severe MPP children. Additionally，reduced breath sounds，coinfection with viruses，LDH > 365. 5 U/L，and CRP > 32. 1 mg/L were risk factors for severe pneumonia in children with pulmonary consolidation. For non-consolidation MPP children，the presence of pulmonary dry rales（OR = 2. 28，95% CI：1. 46 - 3. 56）was the primary indepen- dent risk factor for the development of severe pneumonia. Conclusion The chest imaging findings of MPP are asso- ciated with clinical severity，and the risk factor model constructed based on this imaging-clinical classification can assist in achieving precise hierarchical diagnosis and treatment in clinical practice.