Objective To investigate the value and imaging features of MRI and CT in localization diagnosis of 22 patients with epilepsy. Methods A retrospective analysis was performed on 66 patients with epilepsy who were treated in neurosurgery department of the hospital during the period from June 2016 to June 2018. Twenty-two patients were diagnosed by MRI and CT. Imaging features of the two diagnostic methods and the coincidence rate of combined diagnosis with electrocorticography (ECoG) were observed. Results Of the 66 patients, MRI showed that 12 patients had simple hippocampal atrophy and sclerosis, and 10 patients had simple enhanced signal of amygdala. For hippocampal sclerosis combined with other lesions, brain atrophy and softening lesions were more common. Glial hyperplasia was more common in other lesions. There were no abnormalities in MRI findings of 18 patients. Twenty-two patients underwent PET-CT, and the common lesions were located at unilateral extensive metabolism zone of 7 patients. The coincidence rate of MRI combined with PET-CT with intraoperative ECoC was 72.73%. Chi-square test showed that the difference was statistically significant (P<0.05). Conclusion The location of MRI and CT diagnosis is different. MRI is more reliable for the diagnosis of hippocampus/amygdala. CT can provide more localization information. The advantages of the two are complementary, and the coincidence rate of combined examination is higher.