Objective To investigate the MDCT features of peripheral lung cancer in patients with stage I and analyze the misdiagnosis and differential diagnosis. Methods In our hospital in 2010 may to November 2015 admitted during the period of peripheral lung cancer patients 82 cases were retrospectively analyzed. Application of Ge light speed VCT 64 slice CT scanner of CT examination, statistical lesion morphology, tumor lung interface, edge shape, internal structure and adjacent structures change, summary of stage I lung cancer peripheral MDCT typical signs. Results The T1a phase, T1b phase and T2a phase of I stage lung cancer were all round/round/round, with clear boundary, partially visible vacuole sign, and the truncated pleural indentation and vascular bundle sign. T1a phase, T1b phase and the burr, a rare spike, T2a patients are visible in the sub leaf, a rare spike and spike like. Conclusion MDCT of peripheral lung cancer in I stage has obvious characteristics, which is beneficial to the location and qualitative diagnosis. In addition, phase I of peripheral lung cancer easily misdiagnosed as tuberculoma, spherical pneumonia, inflammatory pseudotumor, hamartoma, in order to improve the detection rate of clinical, need to grasp the main points of differential diagnosis.