Our purpose was to evaluate the usefulness of a 3D T1-weighted gradient-echo sequence (MP-RAGE) in clinical practice. We prospectively examined 200 patients with a variety of neurological disorders and symptoms. We compared lesion conspicuity and contrast enhancement on MP-RAGE images with conventional gadolinium-enhanced spin-echo (SE) T1-weighted images. Both the original MP-RAGE data and the reformatted images were characterised by improved differentiation between grey and white matter. More lesions were found on the 3D series, in both patients with neoplastic and non-neoplastic disease. Contrast enhancement of small oedematous lesions affecting the white matter in demyelinating disease was less obvious. Multiplanar reformatting, which can be realised in any desired plane and surface rendering with sophisticated segmentation algorithms superbly displayed the underlying anatomical relationships between lesions and normal brain structures. Excellent spatial resolution, the absence of posterior fossa artefacts and equivalent contrast enhancement resulted in an increased number of space-occupying lesions being found on the MP-RAGE images. Thus contrast-enhanced MP-RAGE is an alternative to conventional SE imaging in the investigation of intracranial masses. Although the total number of lesions found in patients with demyelinating disease was significantly higher on MP-RAGE, demonstration of blood-brain-barrier breakdown in active lesions was less obvious.