Objective To investigate the application of multi-slice spiral CT (MSCT) in the diagnosis, differentiation and metastasis evaluation of pheochromocytomas. Methods The MSCT imaging data of 74 hospitalized patients with renal pheochromocytomas treated by 131I-MIBG (131I-metaiodobenzylguanidine) in Nuclide Diagnosis and Treatment Center in our hospital were retrospectively analyzed. The CT findings and differential diagnosis of benign and malignant tumors were also analyzed. Results The diagnostic accuracy of MSCT was 95.94%, the sensitivity was 93.75% and the specificity was 95.55%. The differences in size, plain scan phase, arterial phase, venous phase CT values between benign and malignant pheochromocytoma were significant (P<0.05). Benign and malignant pheochromocytomas were complicated with cystic degeneration or necrosis. The enhanced scan was enhanced. Malignant ones were with capsular infiltration. Follow-up found that there was metastasis at different sites and some were complicated with multiple metastasis. Conclusion MSCT can be used as an important imaging method for diagnosis and differential diagnosis of benign and malignant pheochromocytomas and distant metastasis.