Aim To evaluate the diagnostic value of gemstone CT iodine-water based images for acute cerebral infarction after interventional therapy. Methods 31 patients with acute cerebral infarction were found to have abnormal intracranial high density on the immediate gemstone CT scan QC images after the interventional therapy. Iodine-water based images were used to reconstruct and analyze the images. Simultaneously, the iodine based value and water based value of high density were measured, and the images were compared with the results of 24 h ordinary CT review. Results By using iodine-water based images, 17 cases were diagnosed as iodine contrast agent exudation, 14 cases were diagnosed as cerebral hemorrhage transformation, which were identical with the results of 24 h ordinary CT reexamination (Kappa=1,P＜0.01). The immediate postoperative iodine based value:iodine contrast agent exudation(32.09±5.36) g/L, cerebral hemorrhage transformation(6.86±2.26) g/L, there was statistical significant difference (t=53.291, P＜0.01). The immediate postoperative water based value:the iodine contrast agent exudation(1 027.93±8.29) g/L, the cerebral hemorrhage transformation(1 069.68±7.18) g/L, there was statistical significant difference (t =－8.897, P＜0.01). Conclusion Gemstone CT iodine-water based images can accurately diagnose intracranial iodine contrast agent exudation and cerebral hemorrhage transformation after interventional therapy for acute cerebral infarction, which is worthy of clinical promotion.