Background: The diagnostic performance of ultra-high-field ²³Na MRI in predicting the P53 phenotype and Ki-67 labeling index (LI) in adult-type diffuse gliomas is still unknown.No studies have compared its diagnostic efficacy with DWI for distinguishing isocitrate dehydrogenase (IDH) genotype, Ki-67 LI, and P53 phenotype. ̵‌Purpose:‌ To determine whether ²³Na MRI at 7 Tesla (7T) field can accurately predict IDH genotype, Ki-67 LI, and P53 phenotype in adult-type diffuse gliomas and compare efficacy of ²³Na MRI with that of DWI. ̵‌Materials and Methods:‌ 36 glioma patients underwent preoperative ²³Na MRI on a 7T scanner (Siemens Healthcare, Erlangen, Germany). Total sodium concentration (TSC) and apparent diffusion coefficient (ADC), relative ADC (rADC) and relative TSC (rTSC) were acquired. ANOVA was used to compare differences in TSC, ADC, rTSC and rADC within groups. Receiver operating characteristic (ROC) curves and area under the curve (AUCs) were used to evaluate diagnostic performance. ̵‌Results:‌The TSC and rTSC of P53 mutant-type, high Ki-67 LI and IDH mutant-type were higher than that of P53 wild-type, low Ki-67 LI and IDH wild-type, respectively (p=0.009, =0.012, <0.001, <0.001, 0.025, <0.001). rTSC had highest diagnostic efficacy (AUC=0.862) in distinguishing gliomas with different Ki-67 LI. To distinguish different IDH genotype, rTSC had highest diagnostic efficacy (AUC=0.837). rTSC had high diagnostic efficacy (AUC=0.750) when distinguishing gliomas with different P53 phenotype. ̵‌Conclusions: 7T‌ ²³Na MRI can non-invasively distinguish adult-type diffuse glioma with different IDH genotype, P53 phenotype and Ki-67 LI. Compared with DWI (0, 1000 s/mm2), 7T 23Na MRI can have superior diagnostic performance.