Magnetic resonance imaging (MRI) plays an important role in the diagnosis of multiple sclerosis and it has been incorporated into the McDonald diagnostic criteria for MS. In particular, for the exclusion of important differential diagnosis, new MRI markers are established such as the central vein sign. In addition to diagnostic purposes, MS monitoring is getting increasingly important, particularly for purposes of pharmacovigilance. This includes monitoring of treatment efficacy, prediction of treatment response and safety monitoring. Quantitative MRI methods and ultra-high field MRI offer the opportunity for quantitative assessment of damage in the normal appearing brain tissue. However, the standardization of these techniques for implementation in clinical routine will be one of the major challenges in the future.