Objective: To evaluate multimodal MRI of the spinal cord in predicting disease progression and one-year clinical status in amyotrophic lateral sclerosis (ALS) patients. Materials and Methods: After a first MRI (MRI 1), 29 ALS patients were clinically followed during 12 months; 14/29 patients underwent a second MRI (MRI 2) at 1163 months. Cross-sectional area (CSA) that has been shown to be a marker of lower motor neuron degeneration was measured in cervical and upper thoracic spinal cord from T2-weighted images. Fractional anisotropy (FA), axial/radial/mean diffusivities (l H , l // , MD) and magnetization transfer ratio (MTR) were measured within the lateral corticospinal tract in the cervical region. Imaging metrics were compared with clinical scales: Revised ALS Functional Rating Scale (ALSFRS-R) and manual muscle testing (MMT) score. Results: At MRI 1 , CSA correlated significantly (P,0.05) with MMT and arm ALSFRS-R scores. FA correlated significantly with leg ALFSRS-R scores. One year after MRI 1 , CSA predicted (P,0.01) arm ALSFSR-R subscore and FA predicted (P,0.01) leg ALSFRS-R subscore. From MRI 1 to MRI 2 , significant changes (P,0.01) were detected for CSA and MTR. CSA rate of change (i.e. atrophy) highly correlated (P,0.01) with arm ALSFRS-R and arm MMT subscores rate of change. Conclusion: Atrophy and DTI metrics predicted ALS disease progression. Cord atrophy was a better biomarker of disease progression than diffusion and MTR. Our study suggests that multimodal MRI could provide surrogate markers of ALS that may help monitoring the effect of disease-modifying drugs.