Objective To analyze the imaging diagnostic value of CT and magnetic resonance imaging (MRI) in patients with multiple spinal Langerhans cell histiocytosis (LCH). Methods The imaging data of 12 patients with multiple spinal LCH from January 2010 to January 2018 were studied. The pathological examination was used as the standard to analyze the application value of CT and MRI in the disease. Results Among 12 patients confirmed by pathological examination, 9 cases were single-center lesions with adjacent vertebrae invasion and 3 cases were multi-center lesions, and 33 vertebral lesions were found, including 20 core vertebral lesions and 13 adjacent vertebrae invasions. 33 vertebral lesions were found by CT scan, including 20 core lesions and 13 adjacent invasions, and the lesion detection rate of CT examination was 100%, and 1 case was given enhanced scan, and 1 core lesion was detected, and the enhanced scan showed no obvious uneven enhancement. 33 vertebral lesions were detected by MRI examination, including 20 core lesions and 13 vertebrae invasions, and the lesion detection rate of MRI examination was 100%, and 7 cases were given enhanced scan, and a total of 10 core lesions were found, of which 9 were obvious even enhancement and 1 was obvious uneven enhancement in the enhanced scan. Conclusion The diagnosis of multiple spinal LCH is still based on pathological examinations such as puncture or surgery. MRI and CT have their own advantages and disadvantages in the diagnosis of disease. A correct judgment can be made after comprehensive analysis of imaging data and clinical features.