Ultra-low-field MRI: a David versus Goliath challenge in modern imaging

Ultra-low-field magnetic resonance imaging (ULF-MRI), operating below 0.2 Tesla, is gaining renewed interest as a re-emerging diagnostic modality in a field dominated by high- and ultra-high-field systems. Recent advances in magnet design, RF coils, pulse sequences, and AI-based reconstruction have significantly enhanced image quality, mitigating traditional limitations such as low signal- and contrast-to-noise ratio and reduced spatial resolution. ULF-MRI offers distinct advantages: reduced susceptibility artifacts, safer imaging in patients with metallic implants, low power consumption, and true portability for point-of-care use. This narrative review synthesizes the physical foundations, technological advances, and emerging clinical applications of ULF-MRI. A focused literature search across PubMed, Scopus, IEEE Xplore, and Google Scholar was conducted up to August 11, 2025, using combined keywords targeting hardware, software, and clinical domains. Inclusion emphasized scientific rigor and thematic relevance. A comparative analysis with other imaging modalities highlights the specific niche ULF-MRI occupies within the broader diagnostic landscape. Future directions and challenges for clinical translation are explored. In a world increasingly polarized between the push for ultra-high-field excellence and the need for accessible imaging, ULF-MRI embodies a modern "David versus Goliath" theme, offering a sustainable, democratizing force capable of expanding MRI access to anyone, anywhere.