Objective To investigate the characteristics of patients with intrapancreatic accessory spleen (IPAS) and the reasons for misdiagnosis to improve the understanding of the disease and reduce misdiagnosis and unnecessary surgery. Methods A retrospective analysis was made on 10 patients (12 lesions in total), who were admitted to the Department of Hepatobiliary Surgery of First Medical Center or Department of General Surgery of Second Medical Center of Chinese PLA General Hospital from January 2012 to August 2022, and were preoperatively diagnosed as pancreatic neuroendocrine tumor and postoperatively confirmed as intrapancreatic accessory spleen by pathology. Their CT, MRI, ⁶⁸Ga-dotatate PET/CT images, pathological characteristics and clinical data were investigated. Results Out of 10 patients, nine had single lesion, and one had three lesions; 12 lesions were located in the tail of the pancreas, having clear borders with surrounding tissues, being nodules with rich blood supply, and having a maximum diameter of 0.30-3.00 (1.43±0.75) cm. On MRI, all lesions showed hypointensity on T1W1, eight hyperintensity on T2W1 (80%), seven hyperintensity on DWI (70%), six uniform enhancement in arterial phase, and one "patina-like" uneven enhancement. The lesions in the three patients who underwent ⁶⁸Ga-dotatate PET-CT all showed hypermetabolism, and the maximum standard uptake value (SUVmax) was about half of that of the spleen. Conclusion IPAS is generally located in the tail of the pancreas, with less than 3 cm and a clear boundary. The lesions show hypointensity on MRI T1W1 sequence, hyperintensity on T2W1 and hyperintensity on DWI sequence. The typical "patina-like" uneven enhancement is rarely seen in the arterial phase, venous phase and delayed phase display uniform enhancement mostly, and hypermetabolism may occur during ⁶⁸Ga-dotatate PET/CT examination.