The present study is an attempt to determine the prognostic capability of magnetic resonance imaging (MRI) in patients with a spinal cord injury (SCI) in the acute phase. The overall management of SCI patients is a prime consideration, and special precautions are required when the patient has respiratory distress. Twelve patients with a complete cervical injury accompanied by respiratory distress were examined by MRI, and a correlation of the MRI findings and the respiratory problems were investigated. In three cases with severe respiratory distress, the SCI was present above the C4-5 level, and MRI showed a high signal intensity at the upper C3. The severity of the respiratory failure was well correlated with the upper margin of the high signal intensity on T2-weighted images.