Objectives <p>To investigate the value of 3-T MR nerve/bone fusion imaging in grading cervical neural foraminal stenosis (CNFS).</p> Materials and methods <p>Fifty-eight healthy participants and 23 patients with suspected cervical radiculopathy were prospectively enrolled. MR nerve and bone sequences were 3D-T2-weighted fast field echo (3D-T2-FFE) and fast field echo resembling a CT using restricted echo-spacing (FRACTURE), respectively. The agreements of overall image quality, image artifacts, the width of cervical neural foramen (WCNF), and the width of extraforaminal nerve root (WENR) were assessed on 3D-T2-FFE/FRACTURE fusion images in healthy participants. The detection rate, visibility score of extraforaminal nerve root (ENR), and the CNFS grade were compared for patients between the 3D-T2-FFE/FRACTURE fusion image and the T2-weighted images (T2WI). The correlation between CNFS grade and the neck disability index (NDI) and numerical pain scale (NPS) was assessed.</p> Results <p>The agreements were moderate to good for overall image quality and image artifacts (<i>κ</i> = 0.614–0.867), and good to excellent for WCNF and WENR (ICC = 0.755–0.931). The detection rate of ENR on 3D-T2-FFE/FRACTURE fusion (184/184, 100%) was higher than that on T2WI (116/184, 63.04%). The agreements for CNFS grade were substantial to nearly perfect on 3D-T2-FFE/FRACTURE fusion (<i>κ</i> = 0.774–0.837), and moderate on T2WI (<i>κ</i> = 0.436–0.636). The CNFS grade on 3D-T2-FFE/FRACTURE fusion was moderately correlated with NDI (ρ = 0.49)/NPS (ρ = 0.55), while there was no correlation between T2WI and NDI/NPS.</p> Conclusion <p>Compared with T2WI, 3D-T2-FFE/FRACTURE fusion provides a more reliable and reproducible evaluation of the severity of CNFS. The CNFS grade based on 3D-T2-FFE/FRACTURE fusion is associated with clinical symptoms.</p> Critical relevance statement <p>The use of 3-T MR nerve/bone fusion imaging in clinical practice may facilitate a one-stop-shop, radiation-free, and more precise approach to comprehensively evaluate CNFS.</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Grading cervical foraminal stenosis is relatively difficult in clinical practice.</p> </ItemContent> <ItemContent> <p>MR nerve/bone fusion grading of cervical foraminal stenosis is more reliable.</p> </ItemContent> <ItemContent> <p>MR nerve/bone fusion grading of cervical foraminal stenosis correlates with symptoms.</p> </ItemContent> </UnorderedList></p> Graphical Abstract <p></p>