The spinal cord and optic nerve are commonly involved structures in multiple sclerosis (MS) and imaging these regions can have clinical utility in people with MS (pwMS). Here, we discuss recent consensus recommendations regarding imaging the spinal cord and optic nerve in the diagnosis, prediction, and monitoring of pwMS. Standardized protocols are recommended to optimize lesion detection and acquisition time. A spinal cord MRI is routinely recommended for the diagnosis of pwMS. For disease monitoring in established MS, a spinal cord MRI is not routinely recommended, but can be useful in specific situations. Imaging the optic nerve is not routinely recommended for diagnosis or disease monitoring in pwMS. However, in specific situations, including pediatric cases and in patients presenting with atypical symptoms, imaging this region can have clinical utility. These recommendations are intended to provide practical guidance on the effective use of spinal cord and optic nerve MRI in MS clinical practice.