Intractable pediatric epilepsy patients represent a challenging clinical population. Each year, approximately 30,000 new cases of pediatric epilepsy are reported. Approximately 25% of these cases are refractory to medical therapy and patients are often severely debilitated by this disease. In patients with refractory epilepsy, neuroimaging is crucial for precisely identifying epileptogenic foci that are potentially amenable to surgical resection for possible cure. Some, but not all causes of pediatric epilepsy are detectable with conventional MR Imaging. We review structural MR findings in these groups of patients with various pathological entities including focal cortical dysplasia, tuberous sclerosis, mesial temporal sclerosis, neoplasms, etc.