Introduction Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms for which surgical resection is considered the gold standard treatment. Anecdotally, SFTPS are sometimes conservatively managed, but there is little data on this in published literature. In this study, we aimed to collect data on radiological features in SFTP which might be associated with a benign clinical course to assist in risk stratification, and therefore selection for a more conservative management pathway. Methods A service evaluation of outcomes of radiologically diagnosed SFTP was completed in 12 UK centres, between 2005 and 2015. Cases were included via initial search of local radiology databases using key words (“Pleural fibroma” OR “fibrous tumour of the pleura” OR “SFTP”). Baseline characteristics and outcome data was obtained from medical records. Results A total of 270 patients were included in the study. Factors associated with the need for surgical intervention included lesion size (>128 mm), lesion position (abutting the mediastinum or diaphragm), associated pleural effusion, radiological evidence of necrosis within the lesion and heterogenous density. In multivariate analysis, CT-measured attenuation and homogenous density were independent risk factors for adverse clinical outcomes in patients with resected fibromas. Conclusion This is the largest study to date on SFTP to include conservatively managed cases who underwent radiological follow-up only. The results suggest several features associated with adverse clinical outcomes, and thereby may identify cases which could be more conservatively (observation only) managed. Further prospective studies are required to assess the identified risk factors as part of a potential radiological scoring system.