Multiple sclerosis (MS) is the most common of the demyelinating diseases of the central nervous system and thorough descriptions of its usual imaging manifestations abound. Standard unenhanced or enhanced computed tomography (CT) does little more than to aid in the identification of gross white matter changes, and volume loss in advanced cases, while excluding emergent diagnoses such as hemorrhage in a patient with relatively acute neurological deficit(s). The typical periventricular linear lesions as well as frequent corpus callosum involvement are best identified on magnetic resonance imaging (MRI), specifically the sagittal fluid-attenuated inversion recovery (FLAIR) pulse sequence, with assessment of the brainstem and visual pathways best accomplished by dedicated MRI. MS has a predilection for these sites as well as the subcortical U-fibers, and occasionally the cortex and spinal cord. The periventricular lesions occur perpendicular to the ventricles along perimedullary veins (Dawson’s fingers). Acute and chronic lesions are hyperintense on T2-weighted MR images (T2WI). Acute lesions may be isointense or hypointense on T1-weighted MR images (T1WI) and enhance, with enhancement beginning as a solid nodule and then enhancement becoming peripheral. Chronic lesions also may be hypointense- to isointense on T1WI, with hypointense lesions termed black holes.