Objective To explore the clinical value of 3-dimensional CT angiographic (3D-CTA) imaging of vertebral artery. Methods Volume rendering (VR) and shaded surface display (SSD) of 3D-CTA were adopted to examine 67 patients whose primary clinical diagnosis was vertebral artery insufficiency. Among them, 7 were examined with selective vertebral artery angiography.Results One hundred and thirty-three vertebral arteries (52 normal ones and 81 with lesions) were displayed and the rest one was not displayed due to complete occlusion. The lesions consisted of congenital abnormities, compression or displacements caused by traction, rough vascular surface, calcification, lumen stenosis, partial occlusion etc.. The vertebral arteries with developmental abnormities could be complicated with various other lesions, also the lesions might occur on multiple sections of a single vertebral artery; the description was as follows: there were 31 vertebral arteries with congenital abnormities (17 with developmental thinness and 14 with abnormally extended courses); 11 with lesions on initial sections (V1) (10 with roughened vascular surfaces and thin diameter, among which 3 were twisted in an anglular shape and 1 was calcified ); 30 with lesions (13 with the displacements caused by hyperosteogeny compression, 7 with internal displacements caused by traction, 10 with local lesions) on cervical vertebrae sections (V2) and atlanto-occipital section (V3); 55 with lesions (52 with beaded shapes and coarse walls, among which 2 had calcification and 3 partially blocked ) on intracranial sections (V4). Thirteen lesions on 8 abnormal blood vessels out of the 14 blood vessels of 7 patients, who were examined with the selective vertebral artery angiography, had lesions including stenoses displayed as significant by 3D-CTA but displayed as mild by DSA on 2 intracranial sections, and the examining results of 3D-CTA conform to those of DSA for lesions on other 11 sections. Conclusion 3D-CTA can distinctly display the whole course of the vertebral arteries and show its anatomical relationships with vertebrae. 3D-CTA is superior to other angiographic method to display congenital abnormalities and/or calcification of the vertebral arteries and assess the status of vertebral bones. It provides important information for diagnosis of vertebral artery disease.