In recent years, 7-tesla high-resolution magnetic resonance imaging (7 T HR-MRI) has demonstrated significant advantages in evaluating intracranial atherosclerotic plaques due to its ultrahigh signal-to-noise ratio and submillimeter isotropic spatial resolution. This cutting-edge technique enables precise visualization of plaque microstructures, including morphological characteristics and compositional features. Moreover, it allows noninvasive in vivo imaging of small intracranial vessels and provides clear delineation of the anatomical relationship between perforating artery ostia and their parent arteries. Although not yet widely adopted in clinical practice, 7 T HR-MRI shows promising potential for plaque vulnerability assessment, stroke mechanism elucidation, and therapeutic monitoring. This review summarizes recent advancements in 7 T MRI applications for intracranial atherosclerotic disease, aiming to provide novel insights for precision medicine in clinical practice.

In recent years, 7-tesla high-resolution magnetic resonance imaging (7 T HR-MRI) has demonstrated significant advantages in evaluating intracranial atherosclerotic plaques due to its ultrahigh signal-to-noise ratio and submillimeter isotropic spatial resolution. This cutting-edge technique enables precise visualization of plaque microstructures, including morphological characteristics and compositional features. Moreover, it allows noninvasive in vivo imaging of small intracranial vessels and provides clear delineation of the anatomical relationship between perforating artery ostia and their parent arteries. Although not yet widely adopted in clinical practice, 7 T HR-MRI shows promising potential for plaque vulnerability assessment, stroke mechanism elucidation, and therapeutic monitoring. This review summarizes recent advancements in 7 T MRI applications for intracranial atherosclerotic disease, aiming to provide novel insights for precision medicine in clinical practice.