Objective To investigate the MRI findings of recurrent supurative colangitis complicated by intrahepatic cholangiocarcinoma and clinical diagnostic value. Methods 264 patients with recurrent suppurative cholangitis who were admitted into the hospital during June 2010 to November 2014 were selected as the research objects. All of the patients were given magnetic resonance imaging (MRI) and surgical pathological examination or biopsy. The results of surgical pathological examination certified that there 43 patients (52 lesions) complicated by intrahepatic cholangiocarcinoma. The results of pathological examination were taken as the golden standard to evaluate the accuracy, specificity and sensitivity of MRI in the clinical diagnosis of recurrent supurative colangitis complicated by intrahepatic cholangiocarcinoma. The MRI findings were analuzed. Results Among the 264 patients with recurrent supurative cholangitis in this group, there were 43 patients (52 lesions) with complicated intrahepatic cholangiocarcinoma confirmed by surgical pathological examination or biopsy, accounting for 16.3% of total number of subjects; MRI results showed that 218 cases were true negative, 41 cases true positive, 2 cases false negative and 3 cases false positive. The diagnostic sensitivity was 95.3% (41 / 43), specificity 98.6% (218/221) and the accuracy 98.1% (259/264). Conclusion MRI in the diagnosis of recurrent supurative cholangitis complicated by intrahepatic cholangiocarcinoma is of higher accuracy, sensitivity and specificity. MRI findings are obvious. It is worthy of clinical promotion.