Background: Recent advances in neuroimaging have significantly changed the clinical approach to patients with epilepsy. Structural neuroimaging may be able to identify prognostic features in patients more likely to respond to antiepileptic drug treatment. The aim of the study was to assess the role of neuroimaging techniques in the diagnosis of patients with epilepsy. Material and methods: 352 patients with epilepsy, from the National Center for Epilepsy were evaluated by cerebral CT, 1.5 – 3 Tesla MRI and protocol epilepsy MRI. Results: In our study, only 22.2% of the patients, benefited from high-performance neuroimaging by using epilepsy protocol according to international recommendations. CT and low-resolution MRI (below 1.5 Tesla) are able to identify only extended cerebral lesions, like posttraumatic and ischemic gliosis (in 52.5%), arteriovenous malformation. Instead, highly epileptogenic lesions, like cerebral cortical malformations and hippocampal sclerosis were mainly identified by using 3 Tesla MRI with or without epilepsy protocol (5.9% vs 12.7). 64.8% of all patients with epilepsy had structural etiology, but 15.6% still remained with unknown etiology and poor responsiveness to antiseizure medication. Conclusions: MRI techniques greater than 1.5 Tesla remains the gold standard in epilepsy neuroimaging and is crucial in detection of highly epileptogenic lesions and individualized treatment.