Prior to the widespread use of magnetic resonance imaging (MRI), the diagnosis of acute traumatic spinal cord injury (SCI) was largely based on clinical history, physical examination, plain film X-ray, CT scan, and CT myelography. Prognosis was loosely based on the severity of injury whereby individuals presenting with severe injuries were deemed unlikely to recover, and those with mild injuries were thought to recover to a greater extent. The implementation of clinical MRI units from the 1980s to present has offered clinicians an opportunity to view the damaged spinal cord. In this chapter we will (1) describe the meaning of different MRI signal characteristics relative to the pathobiology of SCI as elucidated in animal imaging models, (2) describe how quantitative measurements of spinal cord compression can be used as a tool to determine the degree of spinal cord damage in a patient, and (3) describe how intramedullary MRI signal characteristics can been used as a diagnostic and prognostic tool.
