Although pressure pipelines serve as a secure and energy-efficient means of transporting oil, gas, and chemicals, they are susceptible to fatigue cracks over extended periods of cyclic loading due to the challenging operational conditions. Their quality and efficiency directly affect the safe operation of the project. Therefore, a thorough and precise characterization approach towards pressure pipelines can proactively mitigate safety risks and yield substantial economic and societal benefits. At present, the current mainstream 2D ultrasound imaging technology faces challenges in fully visualizing the internal defects and topography of pressure pipelines. Reverse time migration (RTM), widely employed in geophysical exploration, has the capability to visualize intricate geological structures. In this paper, we introduced the RTM into the realm of ultrasonic non-destructive testing, and proposed a 3D ultrasonic RTM imaging method for internal defects and sensor settings of pressure pipelines. To accurately simulate the extrapolation of wave field in 3D pressure pipelines, we set the absorbing boundary and double free boundary in cylindrical coordinates. Subsequently, using the 3D ultrasonic RTM approach, we attained higher-precision 3D imaging of internal defects in the pressure pipelines through suppressing imaging artifacts. By comparing and analyzing the imaging results of different sensor settings, the design of the observation system is optimized to provide a basis for the imaging and interpretation of actual data. Both simulations and actual field data demonstrate that our approach delivers top-notch 3D imaging of pipeline defects (with an imaging range accuracy up to 97.85%). This method takes into consideration the complexities of multiple scattering and mode conversions occurring at the base of the defects as well as the optimal sensor settings.