Objective: To analyze the value of multi-slice CT cerebral perfusion imaging in the diagnosis of early cerebral small vessel disease (CSVD). Methods: A total of 68 patients with suspected CSVD in the hospital from July 2021 to July 2024 were examined by multi-slice CT cerebral perfusion imaging and MRI, and the consistency of the diagnostic results of the two examination methods was analyzed. According to the results of MRI examination, the patients were graded according to the total load score of CSVD imaging (14 cases of grade 0, 35 cases of grade 1, 19 cases of grade 2). The multi-slice CT cerebral perfusion parameters [cerebral blood volume (CBV), cerebral blood flow (CBF), time to peak (TTP), mean transit time (MTT)] in the core area were compared among patients with different grades, and the correlation among the parameters was analyzed. Results: The sensitivity, specificity and accuracy of multi-slice CT cerebral perfusion imaging in the diagnosis of CSVD were 94.44%, 57.14% and 86.76% respectively. The CBV, CBF, TTP and MTT in the core area of lesions were significantly different among patients with different CSVD grades (P<0.05). Correlation analysis found that the total load score of CSVD imaging was negatively correlated with CBV and CBF (r=-0.786, P<0.001; r=-0.821, P<0.001), and was positively correlated with TTP and MTT (r=0.847, P<0.001; r=0.873, P<0.001). Conclusion: Multi-slice CT cerebral perfusion imaging can accurately evaluate the multi-slice CT cerebral perfusion imaging parameters in the core area of CSVD patients with different degrees of load, and has certain diagnostic value.