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In this review, the authors provide an appraisal of the current literature on the physics principles, histopathologic validation, and clinical applications of advanced diffusion techniques in both brains and spinal cords of patients with MS (neurite orientation dispersion and density imaging, diffusion basis spectrum imaging, multicompartment microscopic diffusion MR imaging with the spherical mean technique, and models enabled through high-gradient diffusion MR imaging). They discuss limitations of each of the methods and directions that future research could take to provide additional validation of their roles as biomarkers of axonal and myelin injury in MS.