Objective To explore the application value of MRI chemical shift imaging in the clinical diagnosis of adrenal adenomas. Methods 110 patients with adrenal adenomas treated from January 2010 to September 2015 were treated as the research objects and MRI was performed in all patients with superconduct 1.5T magnetic resonance machine. Differences of ALR, ASR and AWR values in MRI chemical shift imaging between patients with non-adrenal adenomas and patients with adrenal adenomas. Results Among the 110 cases who underwent MRI examination, 46 cases were with adrenal adenomas (22 cases of non-functional adenomas, 24 cases of functional adenomas). The lesions were mainly round or oval and the boundaries were clear and were connected with the normal adrenal gland. The signal strength on T1WI was relatively homogeneous. In 46 patients with adenomas, 16 patients showed signal decrease in antiphase, 24 cases showed partial reduction and 6 cases had no obvious changes. The ALR values of the non-adenomas were above 0.77 while of adenoma lesions were lower than 0.63; The ASR values of non-adenomas were above 0.73 while of adenoma lesions were lower than 0.59; The AWR values of non-adenoma lesions were above 0.78 while of adenoma lesions were lower than 0.65. There were statistically significant differences in the median values of ALR, ASR and AWR between the two groups (P<0.05). Conclusion The application of MRI chemical shift imaging in clinical diagnosis of adrenal adenomas can achieve effective qualitative diagnosis. With the help of LAR, LSR and LWR values, higher sensitivity can be obtained and it is of great reference value.