Aim of the work: To assess brain abnormalities in neuropsychiatric systemic lupus erythematosus (NPSLE) patients using magnetic resonance imaging (MRI) and to compare the findings to those in SLE patients without neuropsychiatric manifestations as well as to compare disease activity between SLE patients with and without MRI brain abnormalities.Patients and methods: The study was conducted on 55 SLE patients (48 female/7 male) with a mean age of 27.3 ± 4.6 years and disease duration of 4 ± 1.6 years. Patients with NPSLE (n = 30) and without neuropsychiatric (no-NPSLE) (n = 25) underwent MRI brain. The SLE disease activity index (SLEDAI), headache disability index and mini mental state score were considered.Results: Brain abnormalities were detected in 21 SLE patients (38.2%); 16 NPSLE and 5 no-NPSLE. The brain abnormalities included a significantly higher frequency of white matter changes in NPSLE (14 patients; 46%) compared to no-NPSLE patients (5 patients; 20%) (p = 0.038). In NPSLE patients, ischemia was present in 5 patients (16.7%), hemorrhage in 3 (10%) and encephalopathy in another 3 (10%). The SLEDAI was significantly higher in NPSLE patients with cognitive impairment(33.6 ± 9.1) and NPSLE patients with headache (24.2 ± 5.6) compared to the score in no-NPSLE patients (7.2 ± 4.7) (p = 0.001). Patients with MRI brain abnormalities had significantly longer disease duration (p = 0.03), higher SLEDAI (p = 0.001), mini mental state score (p = 0.005) and headache score (p = 0.019) than those without. The study revealed an MRI sensitivity of 0.64.