Objective To review experience in preoperative detection of islet cell tumors using multislice computed tomo-graphy (MSCT) and summarize various imaging features of functioning islet cell tumors on enhanced MSCT.Methods Seventy patients with clinical or pathological diagnosis of functioning pancreatic islet cell tumor between October 2003 and February 2007 were included in this retrospective study. Seventy-four enhanced MSCT scans in these patients were identified. All MSCT scans were interpreted by two experienced radiologists by consensus interpretation.Surgery and pathology reports were used to confirm the diagnosis, localization, and size of tumors.Results Totally, 73 functioning islet cell tumors including 65 benign insulinomas, 2 benign giucagnnomas, 3 ma-lignant insulinomas, and 3 malignant glucagonomas were pathologically diagnosed. Tumors in only two cases were not found by MSCT. In 67 benign lesions, 32 showed typical enhancement style, 21 showed prolonged enhancement in por-tal venous phase, 4 showed delayed enhancement, 4 had iso-dense enhancement with normal pancreatic parenchyma, 2 had no enhancement at all in arterial phase and portal venous phase, and 4 had inhomogeneous enhancement with necro-sis or cyst-formation. Patchy or spotty calcifications were found in 3 of the 67 tumors. In 6 malignant islet cell tumors,vessel invasion (2/6) and bowel invasion (1/6) were seen. Different enhancement patterns were shown. All hepatic metastases showed hyper-enhancement during their arterial phase.Conelusions Pancreatic islet cell tumor may display a wide spectrum of presentations in MSCT. Umors with unu-sual appearances often present as diagunstie challenges. Non-contrast and post-contrast multiphase scans are recommen-ded for the localization of functioning islet cell tumors.