Magnetic resonance imaging (MRI) is of paramount importance for the early 
diagnosis of multiple sclerosis (MS) and MRI findings are part of the MS 
diagnostic criteria. There is a growing interest in the use of ultra-high-field 
strength -7 Tesla- (7T) MRI to investigate, in vivo, the pathological substrate 
of the disease. Areas covered: An overview of 7T MRI applications in MS focusing 
on increased sensitivity for lesion detection, specificity of the central vein 
sign and better understanding of MS pathophysiology. Implications for disease 
diagnosis, monitoring and treatment planning are discussed. Expert commentary: 
7T MRI provides increased signal-to-noise and contrast-to-noise-ratio that allow 
higher spatial resolution and better detection of anatomical and pathological 
features. The high spatial resolution reachable at 7T has been a game changer 
for neuroimaging applications not only in MS but also in epilepsy, brain tumors, 
dementia, and neuro-psychiatric disorders. Furthermore, the first 7T device has 
recently been cleared for clinical use by the food and drug administration.