Purpose <p>Contrast-enhanced 7T MPRAGE is promising for imaging intracranial tumor but suffers from strong intensity inhomogeneities. This study investigated the clinical feasibility of contrast-enhanced 7T MPRAGE with universal pulses (UP) for intracranial tumor imaging.</p> Methods <p>Contrast-enhanced 7T MPRAGE images with conventional circularly polarized (CP) and UP modes were prospectively obtained from patients with known or suspected infratentorial tumors. Two radiologists and a radiology trainee evaluated qualitative image quality scores of the CP and UP images in terms of overall image quality, artifacts, lesion conspicuity, and visualization of cerebellum based on 5-point Likert scales. Contrast ratios (CRs) of enhancing lesion to white matter (CR_lesion/WM) and gray matter (CR_lesion/GM), and white matter in the brachium pontis to white matter (CR_BP/WM) and gray matter (CR_BP/GM) in the supratentorial region were measured using region of interest analysis.</p> Results <p>Fifty-two patients with various infratentorial tumors were included in this study. Contrast-enhanced 7T MPRAGE with UP provided homogeneous image contrast throughout the brain, and clear delineation of enhancing lesions in infratentorial regions. Compared to conventional CP images, UP images achieved higher image quality scores in terms of overall image quality, lesion conspicuity, and visualization of cerebellum scores (<i>p</i> &lt; 0.001), with no significant difference in artifacts scores (<i>p</i> = 0.394). Meanwhile, UP images achieved significantly improved CR_lesion/WM, CR_lesion/GM, CR_BP/WM, and CR_BP/GM in comparison to CP images (<i>p</i> &lt; 0.001).</p> Conclusion <p>UP can be used to generate high-quality and homogeneous contrast-enhanced 7T MPRAGE images for visualization of intracranial enhancing lesions in oncology patients.</p>