An exceptionally broad array of diseases can affect the spinal cord, often in ways that are nonspecific with significant overlap in symptomatology and neurologic exam findings. Neuroimaging is essential in determining the underlying cause and is usually the first diagnostic test to meaningfully reshape the differential diagnosis and adjust which investigations are prioritized. In combination with disease time course, the differential diagnosis can be narrowed by determining a lesion's morphological characteristics, pattern of enhancement, predilection for certain tracts, longitudinal length, and associated radiographic abnormalities. This review provides a brief overview of spinal anatomy using normal spinal cord imaging, followed by a suggested approach to analyzing images and highlighting the radiographic abnormalities unique to each pathology that affects the spinal cord (i.e., autoimmune, infectious, neoplastic, nutritional, structural, and vascular).