The use of paramagnetic contrast agents, in particular, gadolinium-DTPA, holds great promise for the MR evaluation of the spine. However, because of the lack of a previous model for intravenous contrast enhancement in the spine and because of some peculiarities of enhancement of spinal lesions, close attention must be paid to the appropriate uses of contrast in MR of the spine. Gadolinium-DTPA appears to be extremely useful in intradural extramedullary disease and intramedullary disease, but its use in extradural disease may best be restricted to certain specific clinical situations.