The clinical utility of intravenous contrast administration for magnetic resonance imaging in neoplastic disease of the brain, non-neoplastic disease of the brain, and in disease of the spine is reviewed. Magnetic resonance imaging (MRI) is the modality of choice for the evaluation of most suspected intracranial and spinal pathology. Contrast use substantially improves lesion detection and differential diagnosis. Applications are discussed in neoplastic disease, infection, vascular disorders, demyelinating disease, and trauma (specifically including in the spine disk herniation). Gadolinium chelates play as important a role in magnetic resonance imaging as do iodinated agents in computed tomography. Contrast administration facilitates time-efficient and cost-effective diagnosis.