Magnetic resonance imaging (MRI) is central to the diagnosis and monitoring of multiple sclerosis (MS). While conventional MRI (1.5 or 3T) is sufficient in clinical practice for detecting and monitoring lesions, it fails to provide a comprehensive and sensitive assessment of the pathology across the entire central nervous system. This limitation has fueled growing interest in the use of 7T MRI systems to gain deeper insight into MS pathophysiological mechanisms. 7T MRI of the brain has already been shown to be transformative , with improved detection of cortical lesions, central vein sign and paramagnetic rim. Although not yet as advanced as for the brain in MS, spinal cord 7T MRI is also increasingly demonstrating its potential. Key advances to date include assessement of increased lesion burden and characterization of refined tissue in both white and gray matter substructures with anatomical MRI, refined atrophy measurements with higher spatial resolutions, enhanced susceptibility-based contrasts, as well as subregional quantitative and functional MRI. Such methods are opening opportunities to facilitate neuroradiological assessment, to better describe gray matter pathological involvement, and to identify potential myelin-related or vascular biomarkers, that can be used for disability risk stratification, monitoring and therapeutic decision-making. Yet, beyond the mere availability of 7T MRI systems in clinical practice and across sites worldwide, 7T SC MRI remains limited by technical challenges, radio frequency coil availability, regulatory constraints, and the need for standardized protocols. This review summarizes the techniques, together with the main findings, that have been applied so far for the study of MS. Most of them being exploratory, we discuss their potential use in clinical practice, perspectives, challenges and remaining unmet needs.
Callot et al. (Wed,) studied this question.
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