Objective To investigate the application differential diagnosis values of CT perfusion imaging in renal cancer and lack of fat type renal angiomyolipoma. Methods From July 2013 to February 2015 in our hospital, 78 renal parenchyma disease for diagnosis and treatment were selected that included 28 patients of renal carcinoma (RC group) and 50 patients of the lack of fat type of renal angiomyolipoma (renal angiomyolipoma group), two groups were given the routine CT scans, CT perfusion imaging and immunohistochemical analysis, and were given the correlation analysis. Results Conventional CT scan showed that the Levy and Splitting positive signs in the renal angiomyolipoma group were 82.0% and 72.0% respectively, while the RC group were 21.4% and 25.0% that the renal angiomyolipoma group were significantly higher than the RC group (P<0.05). The CT perfusion imaging parameters analysis showed that the BF, BV, PS values in the renal angiomyolipoma group were lower than the RC group, but the MTT values were higher than the RC group that compared between the difference were significantly (P<0.05). Immunohistochemistry showed that the MVD and VEGF OD value in the renal angiomyolipoma group were significantly lower than RC group (P<0.05). Linear correlation analysis showed the BF, BV, PS values in the renal cancer and lack of fat type renal angiomyolipoma were positively correlated to the MVD and VEGF OD values (P <0.05), the MTT values were significantly negative correlated to the VEGF OD values (P <0.05). Conclusion CT perfusion imaging in renal cancer and lack of fat type renal angiomyolipoma can accurately reflect lesion formation and tumor microvascular blood flow within the renal parenchyma, and are related to the immunohistochemical indexs, thus has some clinical values in the differential diagnosis.