Objective To investigate the differential diagnosis and clinical application value of computed tomography (CT) and magnetic resonance imaging (MRI) in acute brain injury. Methods 97 patients with acute craniocerebral injury admitted to our hospital from March 2017 to February 2018 were selected as the study subjects. All patients underwent multi-slice spiral CT and MRI examinations.The types of cranial fracture, the location of primary hemorrhage, the image characteristics of primary nerve injury and the diagnostic accordance of CT and MRI in patients with acute craniocerebral injury were compared. Results The sensitivity of CT examination to acute craniocerebral injury was 72.16% (70/97), which was lower than 86.59% (84/97) of CT examination. The difference was significant (P<0.05). There was no significant difference in the coincidence rate of CT and MRI in diagnosis of cranial fracture type, primary bleeding site and primary nerve injury (P>0.05). CT images of skull fracture showed discontinuity of internal and external skull plates, localized depression of depressed skull to intracranial, and comminuted fracture showed free bone fragments. CT and MRI images of hematoma were similar, showing "double convex mirror-like" abnormal density shadow. MRI images showed spindle hematoma with low occupancy effect. In acute stage, hematoma showed T1 weighted iso-signal. The performance of hematoma on CT images changed with time, from high density, iso-density, liquid low density. CT manifestations were small patches of decreased density at the corticomedullary junction of bilateral cerebral hemisphere, blurred boundary, long T1 and long T2 signals on MRI, and spotted high signal on FLAIR sequence. Conclusion CT and MRI can effectively display different imaging features of acute craniocerebral injury, but the sensitivity of MRI to acute craniocerebral injury is slightly higher than that of CT. Imaging examination can be selected according to clinical needs.