The value of magnetic resonance (MR) imaging in evaluating granulomatous spinal infection was retrospectively assessed in 81 patients with proved disease; 27 were reexamined after administration of gadolinium diethylenetriaminepentaacetic acid, and 25 underwent follow-up studies. Blinded interpretations were correlated with clinical, microbiologic, and surgical findings. MR imaging enabled prediction of the presence of neurologic complications in 93% of patients and diagnosis of the type of infection in 94%, and correlated well with surgical findings in 24 of 27 patients. Vertebral intraosseous abscesses, meningeal involvement, subligamentous spread, and paraspinal abscess location were best identified on contrast-enhanced studies and were seen most frequently in tuberculous spondylitis. High signal intensity on T1-weighted images of previously affected vertebrae suggested healing and correlated well with symptoms. The authors conclude that MR imaging may be useful as the method of first choice for the initial assessment and posttherapy follow-up of patients with granulomatous spinal infection.