MR imaging has had a major impact on understanding the dynamic neuropathologic findings of multiple sclerosis (MS), early diagnosis of the disease, and clinical trial conduct. The next 10 years can be expected to see further advances with a greater emphasis on large multicenter studies, new techniques and hardware allowing greater imaging sensitivity and resolution, and the exploitation of positron emission tomography molecular imaging for MS. The impact should be felt with a new emphasis on gray matter disease and processes of repair. With new ways of monitoring the disease, new treatment targets should become practical, helping to translate advances in the understanding of immunology and regenerative medicine into novel therapies.