To determine which images provide the most useful information and the best time to perform prognostic MRI. The severity of neurological complications was assessed using the ASIA impairment scale. MRI was first performed within 48 h of injury, and was subsequently performed after 2-3 weeks, 3 months, 6 months, and 1 year. Inpatient SCI medicine unit. Seventy-five patients with acute traumatic cervical spinal cord injury (9 women and 66 men) aged from 19-89 years (mean: 54.7 years). Four characteristic patterns of signal changes were observed on MRI. These patterns correlated well with the severity of spinal cord damage and the clinical outcome. T2-weighted images provided the most useful information, and the best times for prognostic imaging were at the time of injury and 2-3 weeks later.