Cranial magnetic resonance imaging (MRI) for epileptogenic lesion is the first choice for the etiologic diagnosis of epilepsy. Patients with symptomatic epilepsy with a clear epileptogenic lesion are at a higher risk of recurrence after the first seizure and have a very low natural remission rate, so early initiation of antiepileptic drug therapy is recommended for these patients; at the same time, successful withdrawal after treatment is less likely in these patients and most require long-term medication. The success rate of surgery is also significantly higher if the epileptogenic pathology can be detected; patients with refractory epilepsy with normal imaging have significantly lower surgical outcomes than those with abnormal imaging findings. Conventional MRI scans can detect larger structural abnormalities such as tumors and strokes in the brain, but can miss microscopic lesions. For the common causes of refractory epilepsy, such as hippocampal sclerosis, subventricular nodular gray matter ectopia and banded gray matter ectopia, focal cortical dysplasia, and tiny tumors such as embryonic dysplastic neuroepithelial tumors, we need high-resolution special MRI imaging methods to clarify. These special scans generally require high field strength (3.0 Tesla), thin scan layer thickness (2.0 mm¸ conventional 5.0 mm), high pixels, and include multiple T1, T2, FLAIR phases as well as three-dimensional volume acquisition sequences (three-dimensional volume acquisition sequences) at the same time. Some scholars call this special set of MRI examination methods epilepsy scanning protocols. For example, for suspected hippocampal sclerosis, a thin coronal scan perpendicular to the long axis of the hippocampus, including coronal T1 inversion phase, FLAIR phase, etc., can be used, while for cortical dysplasia, FLAIR and T2 phase scans including at least two perpendicular cross directions, or 3D imaging, are preferred. After we performed special high-resolution MRI imaging for epilepsy patients, we have identified gray matter ectopia, hippocampal sclerosis, focal cortical dysplasia, and other lesions missed by conventional MRI scans, and some of these patients have undergone surgical treatment. MRI in patients with epilepsy also requires interpretation by experienced physicians and clinical information on seizures to make a correct diagnosis. 123 patients with refractory epilepsy were scanned with conventional MRI and epilepsy series by Oertzen. The conventional MRI results were interpreted by general radiologists (“non-specialists”) and by experienced radiologists with close ties to the epilepsy center (“specialists”), whereas the epilepsy series scans were interpreted by “specialists” only; by comparing the results with the postoperative pathology, they found that the “non-specialists” conventional MRI reports were more accurate than the “specialists”. They found that the sensitivity of the conventional MRI report was only 39% for “non-specialists” and 50% for “specialists”, while the sensitivity of the epilepsy series scan was 91% for “specialists”, and the sensitivity of the conventional MRI report was 91%. The sensitivity of “expert” seizure series scans was 91%, and 85% of patients with negative MRI reports had localized lesions identified by seizure series scans. The close collaboration between the epilepsy specialist and the radiologist is very important in the diagnosis of epilepsy by imaging. The epilepsy series scan is longer, more expensive, and requires high equipment, so it is difficult to be routinely performed in our daily outpatient clinics. We suggest that the program can be carried out first for patients with refractory epilepsy in central hospitals that are in a position to do so. In clinical work, if an epileptic patient fails to respond to 2 or more reasonably selected antiepileptic drugs, the likelihood of refractory epilepsy is very high, and early clarification of the epileptogenic pathology can give the patient a chance to control seizures surgically, which greatly benefits the patient’s quality of life. (Due to the long examination time, Sequence MRI is currently available at our hospital only for patients admitted to the Epilepsy Center).