Identifying a structural brain lesion on MRI is the most important factor that correlates with seizure freedom after surgery in patients suffering from drug-resistant focal epilepsy. By providing better image contrast and higher spatial resolution, structural MRI at 7 Tesla (7T) can lead to lesion detection in about 25% of patients presenting with negative MRI at lower fields. In addition to a better detection/delineation/phenotyping of epileptogenic lesions, higher signal at ultra-high field also facilitates more detailed analyses of several functional and molecular alterations of tissues, susceptible to detect epileptogenic properties even in absence of visible lesions. These advantages but also the technical challenges of 7T MRI in practice will be presented and discussed.