Objective To investigate the clinical value of 64-row 128-slice brain CT angiography (CTA) in the diagnosis of intracranial aneurysm. Methods The clinical data of 112 patients diagnosed with intracranial aneurysm confirmed by operation in our hospital between January 2012 and July 2015 were collected. All patients underwent CTA after admission, and the imaging data were complete. The CTA imaging findings of intracranial aneurysms were summarized, and the diagnostic value was evaluated. Results Of the 112 cases of patients, CTA detected 110 cases, and 2 cases were negative. The positive rate was 98.21%. The time required for CTA data acquisition was (3.8±0.3)s, and the image reconstruction time was (10.1±0.5)min. In 112 cases of arterial hemangiomas, 125 arterial aneurysms and multiple aneurysms in 10 cases were detected. In parent arteries, there were 50 anterior communicating arteries, 41 posterior communicating arteries, 1 vertebral artery, 23 middle cerebral arteries, 9 internal carotid arteries and1inferior cerebellar artery. 2 aneurysms were missed diagnosed; In terms of shape, 27 were spindle-shaped, 80 were cystic, 14 were irregular and 1 was dissecting aneurysm. Conclusion 64-row rows 128- slice CTA can clearly display the size, shape and characteristics of intracranial aneurysms and accurately determine the diameter of aneurysms. Besides, the examination time is short and cost is low. With the post-processing technique, it can clear the relationship between aneurysms, parent arteries and vascular anatomy, which provides reference for preoperative evaluation. CTA can be used as the preferred method of screening for intracranial aneurysms.