STUDY DESIGN: Retrospective evaluation of MRI and clinical examinations in 60 acute cervical spine cord injury. OBJECTIVES: To determine whether initial MRI appearances of the spinal cord in acute trauma correlate with clinical presentation and prognosis. SUMMARY OF LITERATURE REVIEW: Magnetic resonance imaging was known to be the best imaging modality to evaluate spinal cord injury. However, there was no sufficient report to correlate between clinical presentation, prognosis and findings of mag-netic resonance imaging. METHODS: Sixty patients with cervical SCI were evaluated their clinical manifestations, prognosis and MRI findings. MRI was taken with 10 days after trauma in all patients. The patients initial and final neurologic status and functional outcome were evaluated and correlation with initial MRI findings. RESULTS: Edema 37%, swelling 33%, contusion 20%, normal 10% was found at initial magnetic resonance imaging. The group of edema and swelling was more neurological deficit than other groups and low functional and neurological recovery was found at last follow up. The average length of the edema and swelling was each other 19.8, 20.4 mm. There was more neurological deficit, lower functional recovery in longer length of the edema and swelling. CONCLUSION: There is a close correlation between initial magnetic resonance imaging and final neurological, functional recovery in acute spinal cord injury. Magnetic resonance imaging is useful in predicting the clinical outcome and prognosis.