Clinical Application Value of 7T MRI

Click the blue text to follow usAuthor InformationLou XinCorresponding Author

Director of the Radiology Department at the First Medical Center of the PLA General Hospital, Chief Physician, Professor, and PhD Supervisor;Recipient of the National Outstanding Youth Science Fund. Selected as a leading talent in the National “Ten Thousand Talents Program”, a leading talent in scientific innovation by the Ministry of Science and Technology, and an expert with special government allowances from the State Council.

Main Research Directions:

Imaging diagnosis and clinical research of neurological diseases

Has presided over more than 20 major scientific instrument development projects funded by the National Natural Science Foundation, including outstanding youth projects, key projects, original exploration projects, and major military projects. Has received 3 national and provincial-level awards, published over 160 papers as the first or corresponding author, and has been granted more than 30 national invention patents.

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Xie ZhaobangFirst Author

Attending Physician, PhD student

Main Research Directions:

Neuroimaging

01Source

• Authors

Xie Zhaobang, Lou Xin*

• Citation Format

[1] Xie Zhaobang, Lou Xin. Clinical Application Value of 7T Magnetic Resonance Imaging [J]. Chinese Journal of Medical Imaging, 2025, 33(5): 449-453. DOI:10.3969/j.issn.1005-5185.2025.05.001.

02Abstract

As a significant representative of ultra-high field MRI technology, 7T MRI has begun to transition from research to clinical applications. With its ultra-high spatial resolution and excellent signal-to-noise ratio, it has achieved a revolutionary advancement in imaging from macroanatomy to molecular metabolism, providing essential tools for the precise diagnosis and ultra-micro imaging research of neurodegenerative diseases, cerebrovascular diseases, brain tumors, and bone and joint diseases. It presents new perspectives in early diagnosis, efficacy monitoring, prognostic evaluation, and even exploration of disease mechanisms.

Since the advent of MRI technology in the 1970s, it has become a core tool for clinical diagnosis and scientific exploration due to its non-invasive nature, multi-parameter imaging, and excellent soft tissue resolution. After more than 50 years of development, conventional MRI (1.5T and 3.0T) technology has been widely applied in clinical settings, but it has inherent limitations in displaying small anatomical structures and sensitivity to early metabolic changes, which have become critical factors restricting the development of precise imaging. With the continuous increase in magnetic field strength and ongoing optimization of hardware and software, MRI has gradually transitioned from 1.5T and 3.0T to ultra-high field (UHF), achieving a revolutionary breakthrough in MRI technology. Currently, 7T MRI is the only UHF device approved for clinical research by the National Medical Products Administration, and its sub-millimeter spatial resolution, ultra-high signal-to-noise ratio (SNR), and multi-dimensional imaging capabilities are reshaping the boundaries of medical imaging.

17T MRI Ultra-High Resolution Structural Imaging: Revealing Microstructural “Ultra-Clear Microscope”

In recent years, as UHF-MRI technology has matured, more and more 7T MRI machines have been established in domestic research and medical institutions, making 7T MRI a key tool for ultra-micro imaging research and disease diagnosis and treatment. Compared to conventional 1.5T and 3.0T MRI devices, 7T MRI significantly improves SNR due to increased field strength, achieving sub-millimeter (0.25 mm) spatial resolution, especially excelling in imaging fine structures of the brain.^[1] Research by Düzel et al.^[2] found that 7T MRI can clearly display small anatomical structures such as cortical layers, hippocampal subregions, and basal ganglia nuclei, providing reliable evidence for the early diagnosis of neurodegenerative diseases such as Alzheimer’s disease (AD) and Parkinson’s disease (PD). Wang Xinyu et al.^[3] conducted research based on UHF-MRI technology to improve the detection capability of perivascular spaces, revealing a positive correlation between the number of perivascular spaces and motor symptoms in PD patients, a study that is difficult to achieve with conventional 3.0T MRI. Additionally, the magnetic susceptibility effect of 7T susceptibility-weighted imaging enhances with increased magnetic field strength, significantly improving the detection capability of small vessels, microbleeds, and iron deposits, with sensitivity, specificity, and accuracy in observing the disappearance of the “tail sign” in PD patients significantly higher than traditional 3.0T, which has important clinical significance for the ultra-early diagnosis and timely treatment of PD.^[4] In multiple sclerosis, the detection rate of central small veins in multiple sclerosis lesions using 7T MRI susceptibility-weighted imaging sequences is significantly higher than that of 3.0T, and the presence of central vein sign significantly aids in differentiating multiple sclerosis from other similar white matter lesions, providing reliable imaging evidence for diagnosing multiple sclerosis.^[5] In summary, 7T MRI, with its ultra-high spatial resolution and higher SNR, significantly enhances the ability to display small structures and detect early changes, showcasing unique advantages of UHF-MRI in the diagnosis and research of neurodegenerative diseases.

Based on ultra-high field 7T magnetic resonance time-of-flight angiography (TOF-MRA) technology, it can clearly observe common perforating arteries such as lenticulostriate arteries, choroidal arteries, and pontine median arteries.^[6-7] Li Runze et al.^[6] further evaluated the morphological characteristics of lenticulostriate arteries, providing new perspectives for ultra-micro imaging research of cerebrovascular diseases. Further studies found that 7T TOF-MRA can visualize the morphology of lenticulostriate arteries in patients with middle cerebral artery stenosis, revealing a correlation between middle cerebral artery atherosclerosis and lenticulostriate artery morphological characteristics. The visualization of these ultra-micro structures provides important information for prognosis assessment and etiological research.^[8] Additionally, 7T TOF-MRA can display microaneurysms with diameters <500 μm and collateral vessels in moyamoya disease, providing critical information for surgical planning.^[7,9-10] In summary, in the diagnosis and follow-up of cerebrovascular diseases, studies have confirmed that the image resolution of 7T TOF-MRA is comparable to digital subtraction angiography^[11] and even outperforms it in displaying details of the vascular wall.^[12] This provides a more precise and reliable method for non-invasive diagnosis of cerebrovascular diseases.

In the application of UHF-MRI in brain tumors, due to its higher spatial resolution and SNR, 7T MRI can more accurately identify tumors and display tumor boundaries more clearly, highlighting the unique advantages of UHF-MRI in determining the extent of lesions.^[13] Cheng et al.^[14] compared 3.0T and 7T MRI in displaying internal structures of brain tumors and supplying arteries, finding that 7T can more clearly show internal structures of tumors and surrounding microstructures, providing important evidence for tumor treatment and prognosis. Additionally, 7T can clearly display the infiltration range of tumors and the distribution of adjacent white matter tracts, which is beneficial for assessing the extent of tumor resection and formulating and timely adjusting treatment plans in radiotherapy.^[15] In the diagnosis and differential diagnosis of gliomas, 7T MRI susceptibility-weighted imaging sequences can accurately capture gradient phase characteristics of thickened medullary veins, microbleeds, and necrotic cores in the tumor microenvironment, supporting the formulation of personalized treatment plans.^[16] In summary, 7T MRI holds significant value in the diagnosis and treatment of brain tumors, especially with the integration of structural, functional, and metabolic multimodal imaging methods, providing more comprehensive and rich imaging information for clinical interventions, thereby improving patient prognosis and survival.

Compared to the widespread application of UHF-MRI in the nervous system, the application of 7T in the field of bone and joints is relatively limited. Xu Lin et al.^[17] reported that 7T MRI can distinguish subtle injuries of knee cartilage, such as observing Ramp injuries in the posterior horn of the medial meniscus, with 7T MRI outperforming 3.0T and even arthroscopy, making it the most reliable examination method for diagnosing Ramp injuries. Furthermore, 7T MRI can display trabecular structures with ultra-high resolution, even showing small nerves and microvascular changes around the joints, such as assessing the blood supply and microcirculation of knee cartilage through UHF-MRA of lower limb arteries, which is crucial for the early detection of soft tissue damage, assessment of injury repair, and monitoring of therapeutic efficacy.^[18] In summary, 7T MRI, with its ultra-high resolution and SNR, shows significant advantages in displaying knee cartilage tissue and ultra-micro structures compared to 3.0T, providing important support for ultra-early assessment of knee joint injuries and even promoting research on the pathophysiological mechanisms of bone and joint diseases.

2

7T MRI Functional Imaging: Capturing Neural Activity as a “High-Definition Camera”

From low-field 3.0T to UHF 7T, UHF-MRI can more accurately measure brain blood oxygen level-dependent signals, aiding in the precise identification and assessment of metabolic activity in different regions of the brain. The sensitivity of this blood oxygen level-dependent functional magnetic resonance imaging (fMRI) technology has significantly improved, allowing for the precise detection and localization of subtle changes that are difficult to identify at lower fields.^[19] Samanci et al.^[20] found the potential value of the habenula in the pathophysiology of PD, revealing that changes in its connectivity on 7T MRI functional imaging suggest that this nucleus may be involved in early neurodegenerative changes or compensatory neural remodeling processes, establishing the habenula as a novel imaging biomarker for PD and providing a theoretical basis for developing precision treatment strategies based on habenular circuit regulation. UHF-fMRI can better capture changes in small vessels and neural activity through higher spatial resolution, such as layered fMRI that can resolve functional column structures in the cerebral cortex, providing sub-millimeter spatial information for the localization of epileptogenic foci to support surgical planning and postoperative risk assessment for language function impairment.^[21] The pathology of neuropsychiatric diseases mainly involves imbalances of various neurotransmitters and abnormalities in neural circuits. 7T MRI can provide important imaging support for ultra-early diagnosis and precise individualized treatment of neuropsychiatric diseases by detecting changes in brain functional connectivity and microstructural alterations.^[22] The application of 7T MRI functional imaging in brain tumors can accurately analyze the reconstruction characteristics of functional connectivity networks around brain tumors, identifying spatial topological relationships of motor cortex, language centers, and other brain regions related to higher cognitive functions through multimodal functional localization techniques, providing key imaging evidence for formulating individualized surgical plans to maximize the preservation of critical functional brain areas and reduce the incidence of postoperative neurological deficits.^[23] Additionally, 7T resting-state fMRI has been used in brain tumor research, with higher quality resting-state functional connectivity data having significant value in describing vascular physiology, tumor grading changes, and predicting postoperative neurological changes.^[24-25] In summary, 7T fMRI can dynamically capture changes in small vessels and neural activity better due to its higher SNR and spatial resolution, constructing denser and more reliable functional connectivity networks, which is expected to deepen our understanding of brain functional networks and disease pathophysiological mechanisms. However, due to the longer scanning time of fMRI, clinical applications of 7T fMRI are currently relatively limited.

3

7T MRI Metabolic Imaging: “Imaging Biopsy” at the Molecular Level

Magnetic resonance spectroscopy (MRS) imaging is a non-invasive technique that primarily detects the characteristic resonance frequencies of different metabolites within tissues to obtain concentration information of various metabolites in living tissues. The spectral resolution of UHF-MRS can significantly improve with increased field strength, enhancing the detection capability of metabolic chemical substances and allowing for more precise measurement of metabolites in the body.^[26] Schreiner et al.^[27] revealed that glutamate and gamma-aminobutyric acid may be potential biomarkers for AD in a study based on 7T 1H-MRS imaging, identifying high-risk populations that may develop AD in the future and providing new directions for AD research. Additionally, with increased field strength, MRS supports not only 1H (proton) imaging but also multi-nuclear imaging of other non-proton nuclei such as 23Na (sodium) and 31P (phosphorus), promoting the application of multi-nuclear imaging in humans. Research based on 7T 23Na-MRS in neurodegenerative diseases has revealed that sodium concentration in brain tissue is a non-invasive metabolic imaging biomarker in the early stages of neurodegeneration for AD^[28] and PD.^[29] Therefore, multi-nuclear imaging holds significant clinical importance for the early diagnosis of neurodegenerative diseases. Moreover, 7T 31P-MRS can accurately assess changes in brain energy metabolism. Das et al.^[30] found that the brain energy metabolism index reflected by 7T MRS in a population with mild cognitive impairment may be an early biomarker or predictor for AD, providing new insights for AD research and treatment. The application of multi-nuclear imaging in brain tumors is significant; compared to traditional MRS, 7T MRS has higher chemical shift resolution, allowing for more accurate quantification of metabolites in brain tumors. In 31P and 23Na MRS imaging, it can further reflect changes in ion concentrations within tumor cells, which is crucial for understanding the biological behavior and mechanisms of brain tumors.^[31] In the bone and joint system, 7T 23Na-MRS can detect changes in cartilage components early, even before morphological changes visible at 3.0T, facilitating ultra-early diagnosis and prevention of osteoarthritis characterized by cartilage damage and loss.^[32] In summary, based on the significant advantages of 7T MRS in detecting metabolic microenvironments, it can break through the detection thresholds of traditional low-field devices, accurately analyzing dynamic changes of low-concentration metabolites within brain tissues, revealing the molecular pathological mechanisms of neuroimmune microenvironments, and elucidating disease-related immune regulatory pathways from a metabolic perspective, providing key molecular imaging evidence for the precise formulation of individualized treatment plans and new targeted therapeutic strategies.

Chemical exchange saturation transfer (CEST) imaging, as an emerging imaging technology, enhances CEST signals under 7T-UHF, allowing for the detection of lower concentrations of metabolites, providing new avenues for early diagnosis and intervention of diseases. A type of amide proton transfer-weighted imaging based on CEST technology captures the chemical exchange signals of endogenous protein and peptide amide protons, achieving non-invasive quantitative analysis of protein conformational dynamics within brain tissues, accurately detecting changes in amide proton concentrations and conformations in the tumor microenvironment, quantitatively assessing tumor cell density, proliferation activity (such as correlation with Ki-67 index), and glycolytic metabolic status. This technology not only allows for the quantitative determination of glioma WHO grading through characteristic APT signal differences but also identifies molecular phenotype differences between gliomas and brain metastases based on metabolic heterogeneity, providing specific molecular imaging biomarkers for preoperative precise differential diagnosis.^[33] Additionally, Schmitt et al.^[34] compared glycosaminoglycan CEST imaging with 23Na-MRI in studying glycosaminoglycan content in cartilage after cartilage repair surgery, finding that in vivo glycosaminoglycan CEST imaging may be more sensitive to glycosaminoglycan content in cartilage, useful for evaluating patients after matrix-associated autologous chondrocyte transplantation and microfracture treatment. In summary, 7T-UHF metabolic imaging technology, with significantly improved sub-millimeter spatial resolution and millimolar-level detection sensitivity compared to 3.0T, achieves precise quantitative analysis of the metabolic microenvironment of tissues and may become an important new clinical molecular imaging modality beyond PET, driving the evolution of metabolic imaging from an auxiliary diagnostic tool to a core technology guiding precise therapeutic decision-making, opening up new multidimensional research paradigms for revealing the molecular pathological mechanisms of diseases.

4

Conclusion

As a cutting-edge imaging technology, 7T MRI is constructing a multimodal imaging model by integrating structural, functional, and metabolic imaging, gaining increasing attention and application in medicine and research, promoting the transition of imaging diagnosis from morphological description to mechanistic explanation. Furthermore, in the clinical application of UHF-MRI, it is necessary to complement imaging modalities such as PET and CT while promoting deep integration with artificial intelligence to achieve automatic detection of lesions and disease prediction, providing strong support for disease diagnosis, differential diagnosis, and efficacy monitoring. However, to fully unleash the potential of UHF-MRI technology, further solutions are needed to address technical bottlenecks such as radiofrequency field inhomogeneity, specific absorption rate limitations, and imaging artifacts caused by increased magnetic field strength. In summary, through continuous technological innovation and interdisciplinary integration, the 7T MRI technology will achieve more breakthroughs in the future, ultimately realizing the goals of micro-pathology visualization and predictable disease progression in precision medicine.

Conflict of Interest: All authors declare no conflict of interest.

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