Magnetic resonance imaging (MRI) has been widely used for visualizing trigeminal nerves in trigeminal neuralgia.To assess atrophy and diffusion abnormalities of affected trigeminal nerves in trigeminal neuralgia with 7-T MRI.In this prospective study, 14 patients (mean age 49 years; range 31-64 years) with trigeminal neuralgia underwent 7-T MRI. We measured trigeminal nerve volumes along their course through the pontocerebellar cistern. We also evaluated fractional anisotropy (FA) and quantitative anisotropy (QA) values within cisternal segment and pontine nuclei of the affected-side and unaffected-side trigeminal nerves, using diffusion tensor imaging (DTI). Associations between DTI metrics and Barrow Neurological Institute (BNI) pain scores were examined.The volumes were significantly smaller for the affected trigeminal nerves (33.83 ± 23.12 mm3) than for the unaffected ones (47.76 ± 32.48 mm3; p = 0.008). Cisternal segment FA and QA values were significantly lower in affected trigeminal nerves than in unaffected ones. However, DTI measurements in the pontine nuclei revealed no significant differences between affected-side and unaffected-side trigeminal nerves. No DTI metrics significantly correlated with BNI pain scores.Our results suggest that 7-T MRI allows identifications of atrophy and diffusion abnormalities of trigeminal nerves in trigeminal neuralgia.