Objective To evaluate the value of CT combined with dynamic enhanced MRI in differential diagnosis of benign and malignant adrenal tumors. Methods The clinical data of 79 suspected patients with adrenal malignancy admitted to our hospital from January 2022 to October 2024 were retrospectively collected. Pathological examination results were used as the "gold standard" for the diagnosis of benign and malignant adrenal tumors, and different types of adrenal tumors were analyzed. All patients underwent CT, dynamic enhanced MRI and CT combined with dynamic enhanced MRI, respectively. To compare the diagnostic results, diagnostic efficacy, localization and accuracy of qualitative examination methods of CT and dynamic enhanced MRI alone and combined in the diagnosis of benign and malignant adrenal tumors. Results A total of 43 (54.43%) benign tumors and 36 (45.57%) malignant tumors were detected by pathological examination. Dynamic enhanced MRI alone detected 26 (32.91%) malignant cases, 53 (67.09%) benign cases, 40 (50.63%) malignant cases and 39 (49.37%) benign cases. The accuracy, sensitivity and negative predictive value of CT combined with dynamic enhanced MRI were 89.87%, 94.44% and 94.87%, which were significantly higher than those of CT alone (75.95%, 63.89%, 74.00%) and dynamic enhanced MRI (77.22%, 61.11%, 73.58%). The missed diagnosis rate of CT combined with dynamic enhanced MRI was 5.56%, which was significantly lower than that of CT and dynamic enhanced MRI alone 36.11% and 38.89% (P < 0.05). For 36 cases of malignant tumors, the accuracy rates of localization and qualitative examination by CT were 80.56% and 75.00%, and those by dynamic enhanced MRI were 69.44% and 72.22%. The accuracy rates of localization and qualitative examination by the combination of CT and MRI were 100.00% and 91.67%, which were significantly improved. The localization and qualitative accuracy of CT "dynamic enhanced MRI in benign tumor patients were significantly lower than that of the two combined examinations. The accuracy of joint examination was significantly higher than that of CT and dynamic enhanced MRI alone. Conclusion The diagnostic accuracy and localization accuracy of CT combined with dynamic enhanced MRI are higher than those of each method alone.