Background: Ultra-high-field magnetic resonance imaging (MRI) at a field strength of 7 Tesla (T) has marked a significant milestone in diagnostic imaging since it was approved for clinical use in 2017. Despite the potential to improve image analysis by advances in signal-to-noise ratio, and improved spatial resolution and metabolic imaging, the clinical implementation of 7-T MRI remains limited. Factors that contribute to this limited availability are the high price, the operating costs, the need for specifically educated personnel, and lack of evidence of clinical benefit.

Methods: The aim of this scoping review was to evaluate the evidence of the clinical advantages of 7-T MRI versus MRI at lower field strengths, complementary imaging modalities, and diagnostic standard approaches for neurological and musculoskeletal disorders. We searched MEDLINE, CENTRAL, Embase and Web of Science for this review.

Results: We identified 1966 studies, of which 83 were included in our review. Most studies (73 studies, 88%) examined neurological indications, nine studies (11%) examined musculoskeletal indications, and one study reported on peripheral arterial occlusive disease. Of the neuroimaging indications, cerebrovascular diseases were the most frequently investigated (14 studies), followed by multiple sclerosis (13 studies) and epilepsy (11 studies).

Conclusion: The available comparative evidence varied greatly across indications, with the best-documented evidence being for imaging of epilepsy. Risk of bias overall was high, with limitations in blinding information, study design reporting, and patient recruitment details. The identified evidence gaps underscore the need for comparative research to determine appropriate indications and to understand whether the potential diagnostic advantage of 7-T MRI translates to a tangible clinical benefit for patients. Future studies should include clinically relevant patient outcomes that go beyond radiological metrics.