Objective To compare the value of X-ray, multi-slice CT and MRI imaging in displaying and diagnosis of lesions in patients with spinal tuberculosis. Methods 30 cases of patients with spinal tuberculosis confirmed by pathology during January 2013 to June 2015 were treated as the research objects. Their imaging data (X-ray, multi-slice CT and MRI) were retrospectively analyzed and were compared with the pathological results. While the imaging performances were observed, the positive detection rate of the three in the signs of spinal tuberculosis were compared. Results The positive detection rates of MRI and CT in disc spaces involvements, paraspinal abscesses and spinal canal involvements were significantly higher than those in the control group and the detection rate of MRI was significantly higher. The differences were statistically significant (P<0.05). The detection rate of CT in sequestration was 96.9% which was significantly higher than 34.4% and 31.3% of X-ray and MRI and the differences were statistically significant (P<0.001). Conclusion X-ray, multi-slice CT and MRI in the diagnosis of spinal tuberculosis have their own advantages and disadvantages. CT has a higher detection rate of sequestration while MRI has obvious advantages in the diagnosis of vertebral destruction, paraspinal abscesses and spinal canal involvements.