Ultra-high-resolution 5 T MR neurography: first steps

Magnetic resonance neurography (MRN) is an established technique for peripheral nerve assessment, enabling high-resolution visualization of nerves and simultaneous evaluation of adjacent musculoskeletal structures. Although optimized 3 T MRI remains the clinical standard, whole-body 5 T systems have emerged as a potential intermediate platform between 3 T and 7 T imaging. Direct peer-reviewed evidence for peripheral MRN at 5 T remains limited to a single pilot study of the inferior alveolar nerve, with no prospective validation of the brachial plexus, lumbosacral plexus, or limb nerves. Physical and engineering studies suggest that 5 T MRI may provide greater signal availability than 3 T while presenting less severe radiofrequency-related challenges than 7 T; however, the relevance of this theoretical balance to peripheral nerve imaging remains unproven. The additional signal available at 5 T could theoretically be allocated to higher spatial resolution, greater acceleration, or broader anatomical coverage, but these potential gains have not been validated against optimized 3 T MRN. Potential applications include the evaluation of entrapment neuropathies, traumatic nerve injuries, inflammatory neuropathies, peripheral nerve tumors, and the implementation of quantitative approaches such as diffusion tensor imaging, T2 mapping, and T1ρ imaging. Furthermore, artificial intelligence-based reconstruction, denoising, and acceleration strategies may improve the clinical feasibility of ultra-high-resolution neurography by reducing scan times while preserving image quality. This narrative review examines the limited published evidence, physical rationale, technical requirements, preliminary institutional experience, and research priorities for 5 T MRN.