Aim To investigate the imaging type distribution and clinical characteristics of magnetic resonance imaging (MRI) in patients with internal watershed cerebral infarction (IWSI). Methods The clinical data of 98 patients with IWSI admitted between June 2017 and December 2018 were retrospectively analyzed. All patients underwent MRI and diffusion-weighted imaging (DWI). The MRI imaging type distribution and clinical characteristics were evaluated among patients with IWSI, and the clinical efficacy (National Institutes of Health Stroke Scale (NIHSS)) and prognosis and outcomes (Modified Rankin Scale (mRS)) were evaluated among the patients. Results The fusion type showed periventricular cigar-like lesions, 44 cases (44/8,4.90%) in total. The focal type showed single quasi-circular lesions, 37 cases (37/8,7.76%) in total. Beaded type presented as multiple bead-like lesions in brain watershed area, 17 cases (17/8,7.35%) in total. T1WI sequence of patients with IWSI showed low signal, and T2WI sequence showed high signal change, and T1WI sequence low signal in some patients with hemorrhagic cerebral infarction showed a high signal change. The proportion of combination of cortical watershed cerebral infarction (CWSI) of fusion IWSI was higher than that of focal and beaded IWSI (P＜0.05), and the proportion of moderate or above middle cerebral artery stenosis of fusion IWSI was less than that of focal and beaded IWSI (P＜0.05). The occurrence of plaques and the proportion of unstable plaques of focal IWSI were significantly lower than those of fusion and beaded IWSI (P＜0.05). There were no statistically significant differences in the NIHSS scores at admission, improvement rate and mRS scores at 6 months of follow-up among different types of IWSI (P＞0.05), and the NIHSS scores at 1week after admission of focal IWSI was lower than that of patients with fusion and beaded IWSI (P＜0.05). Conclusions Patients with fusion IWSI have the highest proportion, and there are differences in the clinical characteristics among different imaging types. Fusion IWSI is more likely to be complicated with CWSI and has a higher middle cerebral artery stenosis. Clinical diagnosis of IWSI can be made based on MRI results.