Aim To investigate the display effect of high-resolution magnetic resonance imaging (HR-MRI) on the evaluation of vascular lumen, vascular wall structure and composition in vertebral artery dissection (VAD). Methods 5 patients with VAD who were completed with digital subtraction angiography, magnetic resonance angiography, magnetic resonance imaging (MRI) and HR-MRI were enrolled retrospectively from January 2012 to April 2016 in this study.The diagnostic value of HR-MRI for VAD was compared and analyzed. Results HR-MRI could determine the following:(1)The atherosclerotic plaque of vertebral artery was composed of a large number of lipid core; (2)There was a large area of “false cavity” and completely collapsed “true cavity” in VAD; (3)HR-MRI could effectively distinguish congenital vertebral artery hypoplasia and atherosclerotic plaque. In addition, based on the etiological diagnosis of classic MRI, after HR-MRI scan, 2 patients were treated with lipid-lowering drugs, and 2 patients were treated with dual antiplatelet drugs in a short period of time. Conclusion The application of HR-MRI in the diagnosis of VAD patients can explain the condition of the affected vessel wall in more detail, which can help doctors better identify the pathogenesis of individual patients and select the best therapeutic drug.