Abstract: Objective: Comparative analysis of the correlation between MRI findings and pathological features of acoustic neuroma for the improvement of the diagnostic imaging level of the disease. Methods: Retrospective analysis of 24 cases of acoustic neuroma MRI findings confirmed by surgery and pathology, including morphology, size, signal, diffusion limitation and enhanced scanning enhancement, compared with pathological features. Results: There were 18 solid cystic lesions of acoustic neuroma in 24 cases, 14 cases with internal auditory canal enlargement, 2 cases with Hemorrhage, cerebral tissue edema around 14 lesions, 1 case of solid part was slightly diffuse restricted, enhanced scanning of the solid part of the moderate-obvious strengthening, cystic part without strengthening. The pathological features are the coexistence of Antoni A-type cells and Antoni B-type cells. 4 cases of solid lesions all with internal auditory canal enlargement, 1 case with hemorrhage, 2 cases with peripheral brain tissue edema, 2 cases with mild diffusion limitation, and enhanced scans are moderately-apparently enhanced. Pathological features: mainly rich Antoni A spindle cells.2 cases of cystic enhanced scanning wall enhancement, 1 case with internal auditory canal enlargement, 1 case with peripheral brain tissue edema; 2 cases with capsule, there were no hemorrhagic components and diffuse restricted signs in the lesions. Pathological features: It is mainly composed of Antoni type B cells, and the wall component is Antoni type A cells.Conclusion: MRI findings of acoustic neuroma reflect the pathological features to a certain extent, and MRI examination is helpful for its diagnosis and differential diagnosis.