A heavily T1-weighted three-dimensional (3D) gradient echo sequence utilizing a 180 degrees inversion pulse has become available for clinical use, called magnetization prepared rapid acquisition gradient echo (MPRAGE). With the appropriate choice of repetition time, echo time, flip angle, and inversion time (TI), T1-weighted imaging can be performed with excellent anatomic detail and a good signal-to-noise ratio. We performed an initial evaluation of this sequence for detection of abnormalities of the internal auditory canals compared with conventional spin echo (SE) imaging. Fifteen men and 15 women were evaluated. Diagnoses included normal (n = 15 patients), acoustic neuromas (n = 7 tumors in 4 patients), cerebellopontine angle meningiomas (n = 3), postoperative for acoustic neuroma without residual tumor (n = 2), postoperative with evidence of residual tumor (n = 3), glomus jugulare (n = 1), Bell palsy (n = 1), and vestibular enhancement of probable viral etiology (n = 1). The 3D MPRAGE study consisted of 128 coronal partitions, (10/4/1), 10 degrees flip angle, 130 x 256 matrix, 2 mm slice thickness. TI time of 350 ms, 1 s recovery time, and 5.43 min examination time. All enhancing lesions identified on the conventional SE T1-weighted imaging were also identified on the MPRAGE imaging. No diagnostic difference existed between the MPRAGE and conventional SE sequences when pathology was present, but the MPRAGE sequence did have poorer resolution in the axial reformats related to the 130 x 256 in-plane matrix. While not currently able to replace conventional two-dimensional SE imaging, 3D MPRAGE may provide a valuable adjunct to the routine imaging protocol. This technique could replace the coronal T1-weighted SE sequence and provide excellent gray-white differentiation and many contiguous thin sections without a great increase in overall examination time.