Objective To explore the diagnostic value of magnetic resonance imaging (MRI) combined with 64-slice spiral CT (MSCT) examination in occult rib fractures. Methods: Sixty-nine patients with suspected occult rib fractures admitted to our hospital from March 2022 to January 2024 were selected as the research subjects. All patients underwent MRI combined with 64-slice spiral CT detection respectively. The surgical diagnosis results were taken as the "gold standard" for diagnosing occult rib fractures. Analyze the imaging characteristics of the two examination methods. Analyze and compare the diagnostic results of MRI, 64-slice spiral CT detection and combined examination methods, and analyze their diagnostic value and consistency with surgical diagnostic results. Results Among the 69 patients with suspected occult rib fractures, the surgical diagnosis results showed that 53 cases were positive and 16 cases were negative. The results of 64-slice MSCT examination showed that there were 44 patients with occult fractures. In 22 cases (50%), simultaneous interruption of the cortical bone and trabeculae could be seen in the images. In 24 cases (54.55%), fractures could be seen in the simple cross-sectional images. In 20 cases (45.45%), fractures were diagnosed by combined coronal, sagittal or oblique planes. Simple cortical bone interruption was observed in 13 cases (29.55%) of the images, and simple trabecular bone interruption was observed in 9 cases (20.45%) of the images. The MRI examination results showed that among the 42 positive patients, 12 cases (28.57%) showed high signal on T2WI, low signal with speckled imaging on T1WI, and 20 cases (47.62%) showed linear low signal and irregular linear imaging under the cortical bone on T1WI. In 10 cases (23.81%), no low signal was observed on T1WI but high signal was seen on T2WI. The sensitivity (SEN) and accuracy (ACC) of 64-slice MSCT combined with MRI diagnosis were significantly higher than those of the two methods alone. The missed diagnosis rate of 64-slice MSCT combined with MRI diagnosis was significantly lower than that of the two methods alone (P < 0.05). The consistency of the individual diagnosis results of 64-slice MSCT and MRI and the surgical diagnosis results was significantly lower than that of the combined diagnosis and the surgical diagnosis results (P < 0.05). Conclusion: MRI combined with 64-slice MSCT detection can significantly improve the sensitivity and accuracy of the diagnosis of occult rib fractures, reduce the rate of missed diagnosis, and has a high consistency with the gold standard.