Objective To analyze the MRI findings of patients with acute cerebral hemorrhage and cerebral infarction and their diagnostic value. Methods A total of sixty patients with acute cerebral hemorrhage and 60 patients with acute cerebral infarction were selected from the emergency department of our hospital from February 2017 to April 2018. And they were included into the cerebral hemorrhage group and cerebral infarction group, respectively. All patients underwent MRI examination, all clinical data were complete and imaging data were clear. The MRI findings of lesions were analyzed, including the location, shape, signal and distribution of surrounding edema zones. The χ2 test was performed. Results In the cerebral hemorrhage group, the basal ganglia region (78.33%) was the main location of lesions, and the shape of distribution was mainly round, wedge-shaped and punctate (88.33%).. In the cerebral infarction group, the cerebellum, parietal frontal and temporal lobes (85.00%) were mainly distributed, mainly irregular (76.67%). There were statistically significant differences in the distribution and morphological features of lesions between the two groups (P<0.05). Signals on T1WI, T2WI and DWI in cerebral hemorrhage group mainly were equal signal (91.67%), low signal (71.67%) and mixed signal (70.00%), while those in cerebral infarction group were low signal (71.67%), high signal (65.00%) and high signal (86.67%), respectively (P<0.05). There was no significant difference in T2 Flair signal between the two groups (P>0.05). There was a statistically significant difference in the incidence of DWI hyperintensity edema zone around lesions between the two groups (80.33% vs 30.00%) (P<0.05). Conclusion There are significant differences in MRI findings (location, shape, signal and distribution of surrounding edema zone) between patients with acute cerebral hemorrhage and cerebral infarction, which is of great value for improving the clinical diagnosis rate of both diseases.