Identifying a structural brain lesion on MRI has important implications in epilepsy and is the most important correlate to seizure freedom after surgery in patients with drug-resistant focal onset epilepsy. However, at conventional magnetic field strengths (1.5 and 3T) only around 60-85% of MRI examinations reveal such lesions. Over the last decade, studies have demonstrated the added value of 7T MRI in patients with and without known epileptogenic lesions from 1.5 and/or 3T. However, translation of 7T MRI to clinical practice is still challenging, particularly in centers new to 7T, and there is a need for practical recommendations on targeted use of 7T MRI in the clinical management of patients with epilepsy. The 7T Epilepsy Task Force - an international group representing 21 7T MRI centers with experience from scanning over 2000 patients with epilepsy – would hereby like to share its experience with the neurology community regarding the appropriate clinical indications, patient selection and preparation, acquisition protocols and setup, technical challenges, and radiological guidelines for 7T MRI in epilepsy patients. This article mainly addresses structural imaging, but also presents multiple non-structural MRI techniques that benefit from 7T and hold promise as future directions in epilepsy. Answering to the increased availability of 7T MRI as an approved tool for diagnostic purposes, this article aims to give guidance on clinical 7T MRI epilepsy management by giving recommendations on referral, suitable 7T MRI protocols and image interpretation.

Diffusion imaging is a critical component in the pursuit of developing a better understanding of the human brain. Recent technical advances promise enabling the advancement in the quality of data that can be obtained. In this review the context for different approaches relative to the Human Connectome Project are compared. Significant new gains are anticipated from the use of high-performance head gradients. These gains can be particularly large when the high-performance gradients are employed together with ultrahigh magnetic fields. Transmit array designs are critical in realizing high accelerations in diffusion-weighted (d)MRI acquisitions, while maintaining large field of view (FOV) coverage, and several techniques for optimal signal-encoding are now available. Reconstruction and processing pipelines that precisely disentangle the acquired neuroanatomical information are established and provide the foundation for the application of deep learning in the advancement of dMRI for complex tissues.

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We developed several ASL sequences at 7T with a FAIR-QUIPSS II labeling scheme and various spiral readout strategies using Pulseq. Iterative algebraic image reconstruction was performed with CG-SENSE, using the field evolution data measured with external NMR probes. Robust performance in detecting brain’s perfusion signal was observed in 2D single- and multi-band spiral acquisitions especially at relatively high spatial resolution, without the requirement for a longer scan time. 3D spiral acquisition showed reduced contrast level in perfusion maps and requires further investigation and optimization.