LAUSR

ABSTRACT Stroke and related cerebrovascular diseases are a major cause of mortality and disability. Even at standard‐field‐strengths (1.5 T), MRI is by far the most sensitive imaging technique to detect acute brain infarctions and to characterize incidental cerebrovascular lesions, such as white matter hyperintensities, lacunes and microbleeds. Arterial time‐of‐flight (TOF) MR angiography (MRA) can depict luminal narrowing or occlusion of the major brain feeding arteries, and this without the need for contrast administration. Compared to 1.5 T MRA, the use of high‐field strength (3 T) and even more so ultra‐high‐field strengths (7 T), enables the visualization of the lumen of much smaller intracranial vessels, while adding a contrast agent to TOF MRA at 7 T may enable the visualization of even more distal arteries in addition to veins and venules. Moreover, with 3 T and 7 T, the arterial vessel walls beyond the circle of Willis become visible with high‐resolution vessel wall imaging. In addition, with 7 T MRI, the brain parenchyma can now be visualized on a submillimeter scale. As a result, high‐resolution imaging studies of the brain and its blood supply at 7 T have generated new concepts of different cerebrovascular diseases. In the current article, we will discuss emerging clinical applications and future directions of vascular imaging in the brain at 7 T MRI. HIGHLIGHTSClinically feasible stroke imaging protocols at 7 T have been developed.DWI still limits the use of 7 T MRI in acute stroke patients.Submillimeter cerebrovascular lesions have come within the detection limit of 7 T.7 T allows to study the healthy and diseased intracranial arterial vessel walls.Evaluation of cerebral aneurysms and AVMs may benefit from 7 T MRI.