To explore the diagnostic value of MRI and CT for early cerebral ischemia after operation of severe hypertensive cerebral hemorrhage. Methods A retrospective analysis was performed on the general clinical data of 125 patients with severe hypertensive cerebral hemorrhage who underwent operation in the hospital from January 2017 to January 2021. All patients were subjected to MRI and CT examinations after operation. According to presence or absence of cerebral ischemia, the patients were divided into cerebral ischemia group (n=32) and non-cerebral ischemia group (n=93). General clinical data, MRI and CT characteristics of the two groups were compared. Logistic regression analysis was conducted to analyze the correlation between MRI and CT features and early postoperative cerebral ischemia. Anomogram prediction model was constructed to evaluate the diagnostic value of the two methods for postoperative early cerebral ischemia. Results The cerebral blood flow (CBF) and cerebral blood volume (CBV) in the cerebral ischemia group were smaller than those in the non-cerebral ischemia group, and the mean transit time (MTT) of contrast agent was longer than that in the non-cerebral ischemia group (P＜0.05). Logistic regression analysis showed that history of hypertension, systolic blood pressure, diastolic blood pressure, range of cerebral edema, hematoma volume, CBF, CBV and MTT were related factors affecting early postoperative cerebral ischemia in patients with severe hypertensive cerebral hemorrhage (P＜0.05).The C-index of the nomogram prediction model constructed based on these factors was 0.781 (95%CI: 0.716-0.848), which indicated good discrimination. ROC curve analysis showed that the area under the curve of this prediction model was 0.845 (P＜0.001), and its sensitivity and specificity were 0.872 and 0.856, respectively. The accuracy rate of MRI in diagnosing postoperative early cerebral ischemia was significantly higher than that of CT (P＜0.05). Conclusion CT perfusion imaging (CTP) related parameters are related to early postoperative cerebral ischemia in patients with severe hypertensive cerebral hemorrhage. The risk prediction model constructed based on the above CTP related parameters has good prediction performance. Compared with CT, MRI has higher diagnostic value for early cerebral ischemia after operation of severe hypertensive cerebral hemorrhage, which provides accurate imaging evidence for clinical diagnosis and treatment