Objective To discuss the clinical characteristics, imaging findings and differential diagnosis of brown tumor secondary to Long-term hemodialysis. And to further improve the understanding of the disease. Methods 11 cases of brown tumors were proved by surgical or biopsy pathology. The clinical and pathological features and imaging manifestations were analyzed retrospectively. Results In the 11 cases, the blood dialysis duration 2-15 years, average 7.5 years. Serum alkaline phosphatase and Parathyroid hormone can increased significantly. Of the 11 cases (total of 21 lesions), 10 cases were multi-part bone involved.9 of 11 patients for osteoporosis and 2 cases were osteosclerosis.19 lesions had bone destruction, 16 lesions showed expansive bone destruction, 3 showed soluble bone destruction, 9 lesions had harden edge. 15 lesions in bone destruction had calcification or ossification internal. 4 cases with soft tissue mass, enhanced significantly can be found in some cases. 2 lesions occured in the skull, bone density increased and the plate edge blur. Conclusion Brown tumor secondary to Long-term hemodialysis, there had clear medical history, parathyroid hormone and alkaline phosphatase increased significantly. Diffuse osteoporosis or osteosclerosis. More involved axial skeleton than primary hyperparathyroidism. In bone destruction area had calcifications/ossification and soft tissue significantly improved. Those characteristic features were important to help for the diagnosis of the "brown tumor".