Objective To study the CT imaging features and prognostic risk factors in patients with diffuse axonal injury (DAI). Methods 79 cases of patients with early DAI treated in our hospital from May 2012 to June 2014 were enrolled in this study and were made of the retrospective analysis, among which 2 cases were lost in follow-up. The general data and CT imaging features of the patients were analyzed, and the prognosis was followed up at 6 months after admission. According to the prognosis effects, the patients were divided into the good prognosis group (37 cases) and the poor prognosis group (40 cases). The data of two groups were analyzed by single factor and multi-factor Logistic regression, and the independent risk factors influencing the prognosis of DAI were explored. Results CT imaging analysis showed that there were 58 cases of patients with lesions and 19 cases of patients without lesions in the 77 patients, and there were 27 cases with microbleeds, 24 cases with edema and 7 cases with non-hemorrhagic lesions. And there were 11 cases of low signal in the middle of micro-bleeding and high signal in the peripheral edema images. There were24 cases of bleeding in the cerebral cortex, white matter, the junction of gray matter, the corpus callosum, brain stem, cerebellum, basal ganglia and other tissue interfaces with the diameter below 2mm. There were 18 patients in the acute phase complicated with brain swelling, ventricular hemorrhage, subarachnoid hemorrhage, diffuse brain atrophy and other atypical performance. Factor analysis showed that pupil changes, admission Glasgow Coma Index (GCS) score, number of CT lesions and coma time were independent risk factors for DAI prognosis (P<0.05). Conclusion The formations of micro-hemorrhage and edema lesions are typical CT imaging features of DAI patients. And the pupil changes, admission GCS score, number of CT lesions and coma time are independent risk factors for prognosis, which can provide important basis for early diagnosis and treatment of DAI.