Objective To study the of imaging features of brain magnetic resonance imaging (MRI) in patients with maintenance hemodialysis (MHD) and cognitive dysfunction. Methods 31 cases of patients with MHD and cognitive dysfunction admitted to our hospital from January 2016 to January 2018 were enrolled in observation group, and another 50 healthy examiners were included in control group. The scanning imaging features of brain MRI cranial diffusion tensor imaging (DTI) were analyzed in the two groups. Results The FA values of regions of interest of bilateral frontal lobe, bilateral temporal lobe, bilateral apical lobe, bilateral occipital lobe, bilateral hippocampus, bilateral internal capsule forelimb and bilateral internal capsule hind limb in observation group were lower than those in control group, and the FA value of bilateral frontal lobe and bilateral hippocampus was significantly different (P<0.05). The FA value of left frontal lobe in observation group was significantly lower than that in control group (P<0.05). The FA value of right hippocampus was significantly lower than that in control group (P<0.05). Conclusion The FA values of left frontal lobe and right hippocampus of patients with MHD and cognitive dysfunction are significantly lower than those in normal model, and its left frontal lobe and right hippocampus are vulnerable to damage, and the nerve fiber bundle of white matter is with poor integrity.