Anomalous pancreaticobiliary junction is often associated with biliary tract carcinoma and acute pancreatitis. We assessed the value of image analysis in the diagnosis of patients with anomalous pancreaticobiliary junction (APBJ) and the principles for the treatment of APBJ.Sixty-four patients with APBJ were subjected to ultrasound imaging, endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) before surgery. The diagnostic accuracy of image analysis and their surgical outcomes were evaluated retrospectively.On ERCP and MRCP, the length of the common channel was calculated to be 15 mm or longer in all patients, and the angle of the junction was more than 75 degree in 49 (76.6%) of the 64 patients. Of the 64 patients, 28 were defined of pancreatic duct type (P-C) (28/64, 43.75%), 32 bile duct type (C-P) (32/64, 50%), and 4 common channel type (4/64, 6.25%).Patients with APBJ are often associated with biliary tract and pancreatic diseases, and early detection and correct surgical treatment could avoid serious complications. ERCP and MRCP are accurate in the diagnosis of APBJ.