Abstract： Objective In the present study, the correlation of MRI features and pathological changes was studied and the impact of MRI changes on seizure outcome was analyzed. Methods Between Jan. 2005 and Dec. 2008, clinical data of 121 temporal lobe epilepsy (TLE) patients were collected in our institute. Correlation of MRI features and pathological changes was analyzed statistically. According to MRI features, three subtypes of TLEs including medial (MTLE), lesion - related (LTLE) and paradoxical temporal lobe epilepsy (PTLE) were diagnosed. Postoperatively, patients were divided into seizure - free and non - seizure - free group according to Engel seizure classification. Differences of seizure outcome from surgery among different TLE subgroups were compared. Results Among the 121 TLE patients, 101 showed positive MRI findings and 107 showed positive pathological changes. No difference existed. There was a positive correlation between MRI findings and pathological changes. Seizure outcome of PTLE patients was much poorer than that of MTLE and LTLE patients, while no difference existed between the latter two subtypes. Conclusions MRI was one of the most important examinations for the diagnosis of TLE and plays a major role in predicting seizure outcome from surgery among TLE patients.