To investigate the clinical and MRI characteristics of cerebral palsy children with periventricular leukomalacia (PVL). Methods: We retrospectively extracted information from the electronic medical record system of the Third Affiliated Hospital of Zhengzhou University on cerebral palsy children under 18 years old who were hospitalized for rehabilitation from January 1, 2011, to December 31, 2021. We compared and analyzed different aspects such as gestational weeks, birth weight, classification, Gross Motor Function Classification System (GMFCS), and comorbidities in children with cerebral palsy whose cranial MRI showed PVL. Results: A total of 2012 children with cerebral palsy were included, and among them, 1419 underwent cranial MRI with recorded results. PVL was found in 645 cases (45.45%), including 417 preterm infants (64.65%) and 375 low birth weight infants (58.14%). Among the 321 cases with PVL grading results, grade II PVL accounted for the highest proportion in children with gestational age <32 weeks at 72.53% (8/77), and there was a statistical difference in gestational weeks and PVL grades (P<0.01). Regarding birth weight, grade II PVL accounted for 71.21% (94/132) in children with birth weights between 1500-2500 g and 62.5% (25/40) in those <1500 g, with statistical differences in the distribution of PVL grades across different birth weights (P<0.05). In terms of classification, spastic diplegia accounted for 57.36% (370/645) and spastic tetraplegia for 17.36% (112/645). Regarding GMFCS levels, 65.89% (425/645) had the ability to walk independently. In the 321 cases with PVL grading results, grade III PVL had the highest proportion of spastic hemiplegia at 53.49% (46/86). In terms of GMFCS levels, grade II PVL had the lowest proportion of levels I and II at 48.84% (105/215), and there were statistical differences between types, GMFCS levels, and PVL grades (P<0.01). Regarding comorbidities, among the 505 cases whose last follow-up age was >4 years, there were 181 with intellectual disabilities (35.84%), 78 with epilepsy (12.09%), and 71 with visual impairments (11.01%). In the 321 cases with PVL grading results, those with grade II PVL had the highest rates of comorbid epilepsy and intellectual disabilities, at 17.03% (31/182) and 40.16% (49/122), respectively, with statistical differences between PVL grades and whether there was comorbid epilepsy or intellectual disability (both P<0.05), but no statistical significance between PVL grades and whether there was comorbid hearing or visual impairment (P>0.05). Conclusion: Children with cerebral palsy and PVL detected by cranial MRI present certain characteristics in terms of gestational age, clinical manifestations, and comorbidities. Cranial MRI can provide important evidence for perinatal prevention, early clinical diagnosis, early intervention, and the reduction of sequelae.