Objective The purpose was to characterize the MRI imaging findings and MRI follow up of toxoplasma encephalopathy in AIDS patients. Methods A retrospective review of 12 human AIDS patients with Toxoplasma encephalopathy was performed. Brain MRI of the patients and clinical data were reviewed. Results There were total 58 intracranial lesions found in 12 patients, the number of lesions per patient ranged from 1 to16, all lesions showed hyperintense or isointense in T2WI and hypointense or hyperintense in T1WI, peripheral rim enhancement was seen in 24 lesions. After 2 months treatment, absolutely absorption was found in 7 patients, and partly left was found in 5 patients after 6 months, the longest duration of lesion was one year in 3 patients. Conclusion The intracranial lesions were multifocal in AIDS patients with Toxoplasma encephalopathy, involving mostly the frontal lobe and basal ganglia region. Most of the lesions were nodular or round shaped with peripheral rim enhancement. After the treatment of Toxoplasma gondii, most of the lesions absorbed in a early time, and a small number of the lesions left for a long time.