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Objective To investigate the clinical application of cardiac MRI first-pass perfusion and delayed enhancement in acute myocardial infarction (AMI) and to assess its value in judging AMI myocardial ischemia degree. Methods The Siemens AVANTO (1.5 T) MR scanner was adopted to conduct the MRI film imaging in 25 cases of AMI in our hospital from August 2013 to July 2015, then the contrast agent Gd-diethylenetriamine pentaacetic acid (Gd-DTPA) and normal saline were intra-venously injected, tfl_sr_192_4sl_iPAT sequence was adopted to conduct the first-pass perfusion scan. Bolus injection of half dose of Gd-DTPA and normal saline were performed again, waiting for 5-10 min, the TI-scout scan was conducted to determine the best value of TI, and finally the delay scan was performed by the sequence tfi_psir_single-short_10sl, tfl25_t1_psir_segmented. The infarction position,quality of infarction myocardium (IM), infarct percentage (PSI), left ventricular function parameters and through wall degree were evaluated in each case. Results The myocardial infarction in 25 cases was clearly displayed. The first-pass perfusion of infarction lesion was filling defect, delay was the strengthening area of high signal. Among them, 16 cases were through wall myocardial infarction and 9 cases were non-through wall myocardial infarction. IM averaged (11.2±7.8)g, PSI averaged (8.9±7.3)%, the average ejection fraction was (53.5±16.8)%. Conclusion Applying MRI first-pass perfusion and delayed enhancement in AMI patients can accurately judge the degree and range of myocardial ischemia and has higher guidance value for its clinical treatment and prognosis judgment. [ABSTRACT FROM AUTHOR]