Despite the high sensitivity of magnetic resonance imaging (MRI) in detecting a wide spectrum
of various pathological processes, the specificity of the method to differentiate among these pathologies
and its ability to predict clinical outcomes has been rather below initial expectations. The
main problem arises from the fact that most of the pathologies of the spinal cord manifest with a rather
nonspecific increase of water protons, reflecting local oedema or gliosis. This is a common finding in
most myelopathies, which does not allow a further differential diagnostic distinction in most cases.
The use of contrast media improved the specificity of the method; however, it is still challenging to
differentiate types of myelopathies. Advanced imaging methodologies such as functional MRI (fMRI),
diffusion-weighted and -tensor imaging (DWI/DTI), Magnetic Resonance Spectroscopy (MRS) have been used in the
evaluation of neurologic diseases in the brain and have gained increased acceptance among the clinicians for improving
the specificity of MR technology and for their ability to better correlate with functional disabilities and clinical symptoms
thus providing predictive information about potential outcome. Preliminary results show that, quantitative parameters extracted
by these techniques from the spinal cord can provide surrogate markers of disability for determining prognosis as
well. In this review, we focus on implementing advanced neuroimaging methodologies (DWI/DTI, fMRI and MRS) in
imaging of the human spinal cord for better clinical assessment. Additionally, we review the recent imaging literature advances
in this topics and their clinical applications.