Objective To explore the application value of multi-slice CT angiography (MSCTA)in posterior approach of upper cervical vertebrae.Methods Fifty-one patients with suspected or conformed upper cervical disease were collected and performed cer-vical CTA examination.Twenty three patients underwent internal fixation surgery of posterior upper cervical and reviewed with CTA examination.Volume Render (VR),Maximum Intensity Projection (MIP)and Multi-planar Reformation (MPR)were used to show the courser and anatomical variation of vertebra artery,the shape of vertebrae,the relationship between the vertebra artery and adjacent structure,advantage artery.The distribution of screw placement,including perforation of the anterior wall,the inner wall, the outer wall,the upper wall,the interior wall and the inner wall of occipital were observed by VR,MIP and MPR after surgery, especially the relationship between the screw and vertebra artery,the screw and spinal cord.Comparing the correlation between the screw placement and postoperative symptoms.SPSS1 9.0 statistical packages were used for statistical analysis.Results VR,MIP and MPR can show the courser and nearby space relationship of cervical artery.The number of advantage artery was 25,equilibra-tion was 26,dysplasia variation was 13,course variation was 4.The number of tiny pedicle was 1 6,including 9 cases of ipsilateral advantage artery.The postoperative data analysis of 23 patients showed that:C1 -20,C2 -36,C3 - 1 5,C4 -2,occipital 40.The number of accurate screw placement was 83.Different type of perforation was 30,including 3 screws closing to vertebra artery,1 screw closing to spinal cord.All 23 patients were asymptomatic after surgery.Conclusion MSCTA can reflect the morphology of cervical vertebral,the spatial relationship between cervical vertebral and surrounding structure,which can provide an accurate refer-ence for clinical screw placement and improve the accuracy .The postoperative CTA can show screw placement accurately,which has great reference for the evaluation of clinical success rate of surgery and post-surgery treatment.