Accurate detection of epileptogenic lesions on imaging requires a systematic search for abnormalities with diverse etiologies, appearances, and locations. This article provides a practical approach to the detection of epileptogenic foci for radiologists. First, we review protocols tailored to seizure evaluation. Next, we present a pictorial review of structural etiologies for seizure, including temporal lobe pathologies, developmental malformations, neoplastic lesions, vascular lesions, and infectious/inflammatory processes. We provide a step-by-step, systematic approach to ensure detection of the manifold potential pathologies visible on imaging as well as appropriate correlation with clinical findings. Finally, we present example reporting templates which can ensure efficient reporting by radiologists as well as serve as mnemonic aids.
Lozano et al. (2026) studied this question.