Myelopathy refers to any pathologic process that involves the spinal cord, and can be caused by a variety of different diseases. MR imaging is the primary modality for evaluating the patient presenting with myelopathy. The first step must be the exclusion of spinal cord compression. Although the MR features of many causes of myelopathy overlap, careful attention to the time course of presentation, knowledge of common and uncommon causes of myelopathy, and identification of specific imaging patterns and features can help narrow the differential diagnosis or establish a definitive diagnosis.