Objective To investigate the value of spiral CT enhanced scanning in the differential diagnosis of renal cell carcinoma. Methods Retrospective analysis of the clinical and spiral CT data of 84 patients with kidney disease confirmed by surgery and pathology in our hospital from December 2013 to December 2015. And observed the imaging features and compared with pathological diagnosis results. Results In this group of 84 cases of renal cell carcinoma patients with spiral CT scan, the tumor is located in the upper pole of the kidney in 38 cases, located in the lower pole of the kidney in 34 cases, located near the renal sinus in 7 cases, occupy the whole kidney in 5 cases. The diameter of tumor was 1.2cm~13cm, and the mean diameter was (8.2±2.4)cm. The shape of the tumor was round or oval shaped, irregular shape. The coincidence rate of CT typing and surgical pathologic typing was 83.3%. CT plain scan showed renal parenchymal lesions, the tumor volume was not clear, and the enhancement degree of CT was lower than that in normal renal parenchyma. Conclusion Spiral CT, especially enhanced scan can clearly show the location, size, shape and range of the tumor, and can accurately measure the density of the tumor. It has high application value in the clinical differential diagnosis of renal cell carcinoma. It is worthy of further promotion and application.