Objective To explore the value of multi-slice spiral CT perfusion imaging (CTPI) in monitoring cerebral hemodynamics in evaluation of the treatment and prognosis of patients with hypertensive cerebral hemorrhage. Methods 34 patients with hypertensive cerebral hemorrhage who were treated in our hospital between March 2014 and April 2015 were selected as study object. All underwent CT scan and CTPI examination in acute stage and on the 15th day of treatment. The differences in cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and time to peak (TTP) in the central area, the marginal area and the outer area of hematomas at different time points were recorded. The significance of CTPI detection in evaluation of clinical outcomes and prognosis of patients was analyzed. Results In the acute stage, the differences in hemodynamic indexes of hematomas and the surrounding tissues were statistically significant (P<0.05). The CBV, CBF and MTT levels in central area of hematomas in acute stage were significantly lower than those in the marginal zone and outer area of hematomas (P<0.05). There were no statistically significant differences in TTP levels between the three observation areas in acute phase (P>0.05). Conclusion CTPI detection can accurately distinguish the hematoma lesions in patients with hypertensive cerebral hemorrhage and it plays a positive role in the evaluation of clinical curative effect and prognosis, which is conductive to doctors mastering the dynamic development of the disease and ensuring smooth development of the treatment.