Magnetic resonance imaging (MRI) is the main diagnostic and prognostic tool used in the study and treatment of patients with multiple sclerosis (MS). Visualization of MS pathology by MRI has brought about substantial advances in MS care, including earlier and more accurate diagnoses and the ability to monitor the effects of treatment and visualize subclinical disease activity. Despite these advances, it is well known that standard, clinical MRI fails to visualize much of MS-related pathology. Although current MRI performs well as a tool to measure white matter (WM) inflammation in MS, its ability to quantify gray matter (GM) pathology, meningeal inflammation, neurodegeneration, chronic inflammatory changes, and myelin tissue content is limited. For this reason, researchers continue to strive towards development of new imaging technologies –hoping to bring us closer to in vivo quantification of MS changes analogous to post-mortem histopathology. One such technology is ultra-high field, 7 Tesla (7T) MRI. 7T MRI has been applied to MS and has demonstrated superiority in visualization of WM lesions and GM lesions. Further, 7T MRI has led to the identification of novel biomarkers, such as the central vein sign (CVS), WM lesions with paramagnetic rims, and leptomeningeal inflammation (LME), among others.
In this talk, we will review the data available on application of these techniques in vivo, and review clinical correlations and clinical outcome prediction. Further, with the approval of 7T MRI as a medical device by the FDA in recent years, we will review the potential applications of 7T scanners in clinical settings and for clinical trials.