The recently published 2024 revisions of the McDonald criteria unified and expanded the diagnosis of MS towards a “biological diagnosis” and incorporated new MR imaging (bio)markers. Most prominently, they now incorporate imaging of the optic nerve as the fifth topography for dissemination in space (DIS), as well as the central vein sign (CVS) and paramagnetic rim lesions (PRLs), to facilitate an earlier diagnosis of MS. In addition, certain new MRI measures, such as slowly expanding lesions (SELs) and particularly PRLs, are increasingly used in clinical trials and may enter routine clinical practice in the near future. These developments, along with the 2024 MAGNIMS-NAIMS-CMSC consensus recommendations, suggest a different role for MRI in managing patients with MS and expansion of the MRI acquisition protocols, reading, and interpretation. Here, an imaging expert panel of the German Society of Neuroradiology (DGNR) established consensus recommendations on the role of MRI in the management of patients with suspected or definite MS, endorsed by the German Society of Neurology (DGN). These recommendations incorporate these new developments into the context of the German healthcare system. We suggest minor modifications to the acquisition protocol outlined in the 2024 McDonald criteria and the MAGNIMS-NAIMS-CMSC consensus recommendations. For patients with inconclusive imaging findings and in specific diagnostic situations, we recommend changes to MRI acquisition protocols that incorporate susceptibility-weighted imaging (SWI) sequences to demonstrate CVS and PRLs, as well as optic nerve imaging. Additionally, we provide recommendations on the use of MRI for treatment monitoring, including progressive MS patients.