Objective To analyze the MR manifestations and differential diagnosis of nontraumatic spinal epidural hematoma. Methods 10 patients with nontraumatic spinal epidural hematoma were performed MR plan scan, 7 of which enhanced. 9 cases were proved by surgery and pathology and 1 case were proved by follow up. Results Hematoma occurred in cervical level in 4 cases, cervical-thoracic level in 3 cases and thoracic level in 3 cases. Hematoma were located in the dorsal of spinal cord in 7cases, located in the ventral of the spinal cord in 1 case and both in 1 case. The hematomas in 7 cases were spindle-shaped, 2 were strip-shaped and 1 was oval. Vessel bleeding were found in 2 case, angioma in 2 case and AVM in 1 case by surgery. Hematoma were demonstrated slight hyper intensity on T1WI and slight hypo intensity on T2WI in acute phase. In subacute phase, hematoma showed iso- or hyper signal intensity on T1WI, hypo- or hyper intensity on T2WI, and isointensity on both sequences in chronic phase. The enhanced pattern was different towards period and different reason. Conclusions MR is valuable in diagnosing the nontraumatic spinal epidural hematoma with presenting the extend of lesions precisely, judging the phase of hematoma correctly and help in analyzing the reason some degree.