Aim: To explore the diagnostic value of spiral CT chest enhanced scan for adults with active pulmonary tuberculosis. Methods: The clinical data of 60 adult patients with active pulmonary tuberculosis who were treated in our hospital from January 2018 to November 2019 were retrospectively analyzed. All patients underwent conventional chest radiography and spiral CT chest enhanced scan. The number of tuberculosis diagnosis, the detection rate of special site lesions, and the detection rate of active pulmonary tuberculosis signs by the two methods were compared. Results: In 60 patients, the pathological results confirmed the existence of 75 tuberculosis lesions. The detection rate of spiral CT was 98.67%, which was not statistically significant compared with the detection rate of 92.00% (P>0.05) in the conventional chest X-ray. The detection rate of spiral CT enhanced scans for tuberculosis lesions in special sites was 100.00%, which was significantly higher than that of conventional chest X-ray of 7.69%, and the accuracy rate of active pulmonary tuberculosis signs was 98.85% higher than that of conventional chest X-ray of 79.31%. P<0.05). The difference was statistically significant (P<0.05). Conclusion: Spiral CT chest enhanced scan can not only find special tuberculosis lesions that cannot be detected by conventional chest radiography, but also accurately determine active pulmonary tuberculosis in adults, which is of high diagnostic value.