Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy. It’s often lateralized to one of the two hemispheres in the brain. The clinical process of determining the lateralization of TLE incorporates a variety of pieces of information on a patient’s brain structure and function. Determining the lateralization is crucial for guiding treatment. CBF-ALFF coupling shows promise as a noninvasive neuroimaging measure of neurovascular coupling that could help lateralize epilepsy. Neurovascular coupling describes the couples relationship between neural activity and blood flow. CBF-ALFF coupling uses ASL data to capture a patient’s Cerebral Blood Flow (CBF) and Amplitude of Low Frequency Fluctuations (ALFF) in the fMRI signal to measure neural activity. Using our method of mapping CBF-ALFF coupling in a volumetric space and a sample of 17 Right TLE patients and 21 Left TLE patients, we observed that coupling was lower in the hemisphere where the TLE was lateralized. For Left TLE patients, coupling was lower in their left hemisphere than their right and in Right TLE patients, coupling was lower in their right hemisphere than their left. CBF-ALFF coupling shows promise in future epilepsy research and could help guide clinical decision making.