The clinical utility of 7T MRI in skull base pathology - A narrative review.

INTRODUCTION: Ultra-high field 7 T MRI provides substantially higher signal-to-noise ratio than conventional 1.5 T/3T MRI, enabling superior depiction of neuroanatomy and tissue contrast. These advantages are particularly relevant at the skull base, where complex anatomy and intimate tumour neurovascular relationships may critically impact diagnosis and treatment. This narrative review evaluates current evidence for the use of 7 T MRI in skull base pathology, with focus on tumour detection, characterisation/delineation, and the assessment of compromised neurovascular structures. METHODS: A systematic search of PUBMED and EMBASE was conducted following PRISMA guidelines utilising relevant search terms. Studies published between 1st January 1991 and 25th April 2025 were screened. Included studies assessed skull base pathology using 7 T MRI in in-vivo human subjects. Given the heterogeneity of included studies, results were derived through narrative synthesis. RESULTS: 25 studies met inclusion criteria, comprising 115 patients and 155 controls. Most studies were published after 2019 and were small-scale feasibility or case control studies. Pituitary adenomas were the most commonly investigated pathology, with 7 T demonstrating improved lesion detection, characterisation and anatomical delineation. Several studies also reported the promise of tractography of the posterior visual pathway in patients with pituitary adenomas, with correlations to visual function. CONCLUSION: 7 T MRI shows promise for improved preoperative assessment and spatial characterisation of skull base pathology. Preliminary findings indicate potential utility in identifying novel markers for dysfunction in the adjacent compressed cranial nerves. Further studies to confirm these potential clinical roles in diagnosing skull base tumours and preoperative prognostication of impacted cranial nerves are needed.