Objective To analyze the value of spiral CT three-dimensional reconstruction in the diagnosis of benign and malignant solitary pulmonary nodules. Methods A total of 66 patients with solitary pulmonary nodules who were admitted to our hospital from June 2016 to December 2017 were included as the study subjects. All patients were diagnosed. The results of spiral CT three-dimensional reconstruction and CT plain scan were recorded. The accuracy of spiral CT three-dimensional reconstruction and CT plain scan was observed compared with pathological results. Results In the detection of malignant signs such as vascular cluster sign, pleural indentation sign, short burr sign, vacuole sign and lobulation sign, the detection rate of three-dimensional reconstruction was higher than that on CT plain scan(P<0.05), in the detection of vacuole sign, the positive rate of plain scan was higher than that of three-dimensional scan (P<0.05). The detection rate of short burr sign in three-dimensional reconstruction was slightly higher than that in CT plain scan, but there was no significant difference between them (P>0.05). The diagnostic accuracy of three-dimensional reconstruction imaging for benign and malignant SPN can be as high as 80.30%, which is significantly higher than that of CT scan(60.61%,P<0.05). Conclusion Spiral CT three-dimensional reconstruction has certain value in the diagnosis of solitary pulmonary nodules. It has high accuracy in distinguishing the benign and malignant of solitary pulmonary nodules. However, some lesions can not be completely distinguished or even misdiagnosed. To improve the diagnostic rate, it is necessary to combine various methods such as enhancement and perfusion to improve the accuracy and complement each other, improve accuracy.