Objectives Ultra high field MRI at 7 T is able to provide much improved spatial and contrast resolution which may aid in the diagnosis of hippocampal abnormalities. This paper presents a preliminary experience on qualitative evaluation of 7 T MRI in temporal lobe epilepsy patients with a focus on comparison to histopathology. Methods 7 T ultra high field MRI data, using T1-weighted, T2*-weighted and susceptibility-weighted images (SWI), were acquired for 13 patients with drug resistant temporal lobe epilepsy (TLE) during evaluation for potential epilepsy surgery. Qualitative evaluation of the imaging data for scan quality and presence of hippocampal and temporal lobe abnormalities were scored while blinded to the clinical data. Correlation of imaging findings with the clinical data was performed. Blinded evaluation of 1.5 T scans was also performed. Results On the 7 T MRI findings, eight out of 13 cases demonstrated concordance with the clinically suspected TLE. Among these concordant cases, three exhibited supportive abnormal 7 T MRI findings which were not detected by the clinical 1.5 T MRI. Of the ten cases that progressed to epilepsy surgery, seven showed concordance between 7 T MRI findings and histopathology; of these, four cases had hippocampal sclerosis. SWI had the highest concordance with the clinical and histopathological findings. Similar clinical and histopathological concordance was found with 1.5 T MRI. Conclusions There was moderate and high concordance between the 7 T imaging findings with the clinical data and histopathology respectively. [ABSTRACT FROM AUTHOR]