Aim To investigate the manifestations of several common acute superior mesenteric artery events of multi-slice spiral CT angiography (MSCTA) in order to acknowledge the disease deeply. Methods The clinical and imaging data of 23 cases of acute superior mesenteric artery were reviewed and summarized. Results 9 of 23 cases were isolated superior mesenteric artery dissection(ISMAD),according to classification of YUN,the type Ⅰ(n=7) and the type Ⅱb(n=2),double-lumen sign and low-density intimal flap were seen in all cases. 3 of 23 cases were intramural haemorrhagic(IMH) with out-pouching ulcer crater. 11 of 23 cases were acute superior mesenteric arter thromboembolism(SMAT), the direct signs of which in CT images was filling defect in mesenteric vessels. Conclusion Although the clinical symptoms of ISMAD,IMH and SMAT are similar,but each with typical imaging findings on MSCTA ,which is accurate, fast and effective for the diagnosis of acute superior mesenteric artery events.