Abstract: Objective: To explore the clinical application of multi-modal gemstone spectral CT in acute ischemic stroke. Methods: The spectral noncontrast CT, CTA and CTP images of 58 patients with acute ischemic stroke in our hospital were retrospectively analyzed, and the effect of multi-modal 64 spectral CT in the treatment of ischemic stroke was observed. Results: (1) The iodine (water) value and water (iodine) content of the affected side were significantly lower than those of the contralateral side in spectral noncontrast CT, which showed significant difference while there were no significant differences in the other two indexes of slope of energy spectrum curve curve and spectral CT value. (2) Spectral CT dynamic CTP showed that among the 58 patients, 55 (94.83%) patients had abnormal perfusion, and there were significant differences in MTT, TTP, CBF and other indexes between the affected side and the contralateral side, but no significant difference showed in CBV. (3) The original axial CTA image reconstructed by the original CTP images showed clear vessels of grade 4-5 branches of intracranial vessels. The three-dimensional reconstruction image showed clear vascular structure and slightly rough wall, which could meet the diagnostic requirements. Conclusion: In the dignosis of acute ischemic stroke, multi-modal spectral CT technology has important clinical value, which not only can quickly locate the infarct responsible vessels, distinguish the infarct and ischemic areas, and also holds the advantages of fast examination speed and many parameters.