Abstract: Objective To discuss the value of magnetic resonance tomographic angiography in the diagnosis of neurovascular compression syndrome and its guiding significance for microvascular decompression． Methods The MRTA data of patients with vascular compression syndrome underwent microvascular decompression from July 2008 to May 2015 were collected and compared with the results of intraoperative findings． Results Neurovascular compression or contact (dubious contacts) on symptomatic side were screened out in 284 cases with a positive rate of 94．7%, and in 56 cases for asymptomatic side with a positive rate of 18．7%, demonstrating a significant difference between the two groups (P< 0．05)． During MVD surgery, 292 cases were found with neurovascular contacts or compression． Compared with intraoperative results as the gold standard, the sensitivity, specificity and accuracy of MRTA in the diagnosis of neurovascular compression syndromes were 99．3%, 37．5%, 96．0%, respectively． Conclusion There is a high agreement between MRTA imaging and operative results． MRTA has a high dignostic accuracy in the diagnosis of neurovascular compression syndromes, and by now it is optmal and reliable imaging examination．