Abstract <p>In recent years, the clinical interest and research evidence of intracranial vessel wall MR imaging (iVWI) in vasculopathy lesion detection and characterization have made the technique a mainstay of patient care. Employing techniques with sufficient blood signal suppression (black blood) allows for direct visualization of lesions in the vessel wall itself, and facilitates the detection, evaluation, diagnosis, and differentiation of various cerebrovascular diseases. Clinical applications have extended rapidly to include multiple indications and pathologies, but the level of evidence and confidence varies for each of these indications and needs to be stratified and updated. On the other hand, a recent academic survey emphasized the need for additional technical and educational support in the neuroradiology community. The aim of this article is to provide expert consensus from the Society for Magnetic Resonance Angiography (SMRA) working group members for current clinical practice of iVWI with three levels of recommendation and to explore possible future clinical research applications.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>By direct visualization of the intracranial vessel wall, iVWI facilitates the detection, evaluation, diagnosis, and differentiation of various cerebrovascular diseases</i>.</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Updated evidence indicates that iVWI is now useful for many clinical indications, although challenges remain in certain settings</i>.</p> <p><Emphasis Type="BoldItalic">Relevance statement</Emphasis> <i>With the advancement of hardware, improved resolution, innovation of sequences, post-processing, and analysis, iVWI has become promising in a variety of clinical indications to facilitate the evaluation and potentially improve the management of multiple cerebrovascular diseases</i>.</p>