Objective To investigate the value of MRI in the diagnosis and differential diagnosis of spinal tuberculosis and metastatic tumors. Methods A total of 49 cases of spinal tuberculosis diagnosed in our hospital (tuberculosis group), 69 cases of patients with spinal metastatic tumors (metastasis group), from January 2013 to January 2017, MRI images of two groups were retrospectively analyzed, according to the pathological results as the gold standard to determine the detection, calculation of MRI examination in the differential diagnosis of spinal tuberculosis the clinical value of tumor metastasis. Results The lesions of tuberculosis group and metastasis group located in the vertebral body distribution, the cumulative incidence of intervertebral disc lesions, imaging morphology, paraspinal mass signal enhancement incidence of vertebral bodies and T2 weighted images showed soft tissue lesions, the signal, the differences were statistically significant (P<0.05), single lesion group and metastasis of tuberculosis tumor group or multiple cases, the type of bone destruction, vertebral compression deformation contour comparison, the difference was not statistically significant (P>0.05), to determine the pathological results as the gold standard, the sensitivity of MRI in diagnosis of spinal tuberculosis and spinal metastases was 91.84%, the specificity was 86.96%, the misdiagnosis rate was 8.16%, misdiagnosis the rate was 13.04%, the positive predictive value was 83.33%, the negative predictive value was 93.75%. Conclusion MRI for spinal tuberculosis, metastatic tumors have a high differential diagnosis.