Objective To observe the effect of magnetic resonance (MRI) combined with multi-slice spiral CT on the diagnostic accuracy of hepatic encephalopathy (HE). Methods A total of 75 cases of HE patients treated in our hospital from October 2014 to December 2016 were selected as the study group, and 73 healthy persons were taken as the control group in the same period, both groups underwent MRI, multi-slice spiral CT examination, and the clinical manifestations of the study group were analyzed statistically, and compared the sensitivity, specificity and accuracy of MRI and multi - slice spiral CT. Results The sensitivity, specificity and accuracy of combined diagnosis (98.66%, 97.26%, 97.97%) were higher than those of MRI (82.66%, 82.19%, 82.43%), multi-slice spiral CT (80.00%, 83.56%, 81.76%) single diagnosis, the difference was statistically significant (P<0.05). 75 HE patients, 67 patients with chronic HE, midbrain ventral high signal of 16 cases, T1W1 sequence showed 55 cases of high signal of bilateral basal ganglia globus pallidus, pituitary anterior high signal of 22 cases, 44 cases of multi-slice spiral CT and MRI showed brain atrophy; 8 cases of acute HE patients, 5 cases of ventral ventral and bilateral basal ganglia globus pallidus high signal, 4 cases of multi-slice spiral CT and MRI showed diffuse brain edema. Conclusion MRI combined with multi-slice spiral CT can improve the diagnostic sensitivity, specificity and accuracy in the diagnosis of HE, and provide important guidance for diagnosis and treatment of HE patients.