Objective To investigate application value of magnetic resonance imaging (MRI) in hippocampal sclerosis (HS) in patients with epilepsy. Methods 147 temporal lobe epilepsy patients with suspected HS treated in the neurology department and 124 cases of health examinees in the medical examination center of our hospital from January 2013 to December 2016 were selected. The MRI diagnostic rate, fractional anisotropy (FA), apparent diffusion coefficient (ADC), and functional manifestations of the selected patients were observed and analyzed. Results 136 cases (92.52%) with HS were diagnosed by MRI, of which 61 cases (44.85%) was bilateral and 75 cases (57.35%) were unilateral with 31 cases (21.09%) being right side and 44 cases (58.67%) left. The proportions of tumor, inflammatory lesions and no obvious abnormalities were 2.04% (3 cases), 1.36% (2 cases) and 4.08% (6 cases). 141 cases (95.92%) were detected with lesions by MRI. MRI showed that the volume of bilateral hippocampus in the observation group was significantly lower than that in the control group (P<0.05). The FA and ADC values of 31 patients with right HS were significantly lower than those of the contralateral and control groups (P<0.05). The FA and ADC values of 34 patients with left hippocampal sclerosis were significantly lower than those of the contralateral and control groups(P<0.05). Moreover, there was a significant linear correlation between the FA and ADC values of the hippocampus and the hippocampal volume and duration of the affected side. Conclusion MRI can clearly display the morphology and functional manifestations of HS, provide accurate location and qualitative diagnosis for clinical treatment, and play an important role in preoperative evaluation of patients.