Abstract: Objective: To investigate the diagnostic value of two-dimensional and three-dimensional fused images in trigeminal nerve MRTA examination for trigeminal neuralgia (TN) and Hemifacial spasm（HFS）. Methods: Imaging data of 73 patients with MRTA, including 48 patients with TN and 25 patients with HFS, were retrospectively analyzed. The consistency of the location relationship between the trigeminal nerve and facial nerve adjacent to blood vessels in the two groups of images was analyzed by 2 physicians, and the difference between the results of the two-dimensional image group and the three-dimensional image group was compared. Based on the gold standard of surgical results, the diagnostic efficacy of each image group on the relationship between symptomatic nerves and vessels was calculated. Results: The sensitivity of 2D images and 3D images to diagnose the relationship between trigeminal nerve and blood vessel were 87.5% and 93.8%.The sensitivity of diagnosing the relationship between facial nerve and blood vessel were?84.0% and 92.0%.. The accuracy rate of diagnosing the relationship between facial nerve and blood vessel is 92%. Conclusion: The fused 3D images can more clearly show the relationship between nerve and blood vessel, which has a higher diagnostic value for vascular trigeminal neuralgia and facial spasm.