This essay illustrates the imaging spectrum of vascular neoplasms and malformations, ischemia, and hemorrhage affecting the spinal cord. Most of these abnormalities occur far more frequently in the brain. The goal of this essay is to provide a sound anatomic and radiologic basis for the evaluation of these diseases. Knowledge of the unique cross-sectional anatomy, blood supply, and venous drainage of the spinal cord is essential in understanding the radiographic appearance of certain vascular lesions. The superior spatial resolution of fast spin-echo pulse sequences and improvements in MR angiography have expanded the role of MR imaging in the diagnosis of spinal cord diseases. These techniques are emphasized in this essay, and potential diagnostic pitfalls are highlighted. The diseases illustrated are grouped in the categories of enlarged vessels, ischemia, and hemorrhage.