The spinal cord is a clinically eloquent region, whose damage has the potential to affect dramatically the functional outcome of patients with multiple sclerosis (MS). During the last 10 years, thanks to the development of sophisticated magnetic resonance imaging (MRI) techniques, MRI of the spinal cord has been made feasible and contributed significantly to increase the confidence in the diagnostic work-up of patients suspected of having MS and to grade the severity of overall central nervous system (CNS) damage associated to the disease. Technical development in acquisition and postprocessing of spinal cord MRI is likely to increase in the near future our understanding of disease pathobiology through an increased ability to define the nature and location of spinal cord damage as well as through an accurate functional mapping of its activity, which might have an adaptive role in limiting the consequences of structural CNS injury due to MS.
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