Objective To observe the values of multi-slice spiral CT angiography (MSCTA) in the diagnosis and follow-up evaluation of aortic intramural hematoma (AIH). Methods The clinical and follow-up data of 14 AIH patients were retrospectively analyzed. The imaging features of MSCTA in diagnosis and follow-up of AIH were observed. Results Among the 14 cases of AIH patients, there were 3 cases (21.43%) with Stanford type A and 11 cases (78.57%) with Stanford type B. There were 12 cases (85.71%) of aortic crescent thickening and 2 cases (14.29%) of ring thickening. 10 cases (71.43%) were visible aortic wall calcification plaque and 9 cases (64.29%) were calcified plaque migration. There were 11 cases (78.57%) of canker ulceration in aorta, of which 9 cases (64.29%) were located in the hematoma of the wall and 2 cases (14.29%) were located outside the hematoma of the wall. Endometrial leakage was seen in 1 case (7.14%), pleural effusion in 6 cases (42.86%) and pleural effusion with pericardial effusion in 1 case (7.14%). At 12 weeks follow-up, 11 cases (78.57%) completely absorbed hematoma, and 2 cases (14.29%) basically absorbed and 1 case (7.14%) obviously absorbed, and 0 cases (0.00%) were with absorption improvement and 0 cases (0.00%) with no improvement. Conclusion MSCTA can display all kinds of imaging features of AIH comprehensively and intuitively, and it is a noninvasive examination with good repeatability, and it can reflect the treatment of AIH in time and is helpful to the diagnosis and follow-up examination of AIH.