Objective To compare the MRI findings between the acute suppurative cholangitis and nonsuppurative cholangitis, and to evaluate the role of MRI finding in the differential diagnosis. Methods To retrospectively study 33 patients with acute suppurative cholangitis whom were confirmed pus accumulation of biliary ducts during the surgical removal of biliary duct stones. 45 patients with nonsuppurative cholangitis and biliary duct stones were randomly selected. The following MRI findings were compared and analysed: the presence of common bile duct stones, intrahepatic bile duct stones, bile duct dilatation, intrahepatic bile duct dilation, bile duct thickening, cholecystitis, and hepatic abnormal lperfusion, and the maximum diameter of the common bile duct stones. The sensitivity, specificity and accuracy of MRI findings in the diagnosis of suppurative cholangitis were calculated. Results On MRI, there were significant difference between acute suppurative cholangitis and nonsuppurative cholangitis for the presence of common bile duct stones and hepatic abnormal perfusion(P≤0.05), and there were no significant difference between acute suppurative cholangitis and nonsuppurative cholangitis for the presence of intrahepatic bile duct stones, bile duct dilatation, intrahepatic bile duct dilation, bile duct thickening, cholecystitis, and the maximum diameter of the common bile duct stones(P≥0.05).In multivariate logistic analysis, common bile duct stones and hepatic abnormal perfusion were the significant MRI predictors of acute suppurative cholangitis. Common bile duct stones showed higher accuracy with 60%, hepatic abnormal perfusion showed higher specificity with 79%, the combination of the two MRI findings improved the specificity with 85% in diagnosis of acute suppurative cholangitis. Conclusion On MRI, the common bile duct stones and hepatic abnormal perfusion were valuable findings to different acute suppurative cholangitis and nonsuppurative cholangitis, and can provide help for clinical diagnosis and treatment options.