〔Abstract〕 Objective 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.Methods 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 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.