Abstract We conducted speckle imaging observations of 53 stellar systems that were members of long-term radial velocity (RV) monitoring campaigns and exhibited substantial accelerations indicative of planetary or stellar companions in wide orbits. Our observations were made with blue and red filters using the Differential Speckle Survey Instrument at Gemini-South and the NN-Explore Exoplanet Stellar Speckle Imager at the WIYN telescope. The speckle imaging identifies eight luminous companions within 2″ of the primary stars. In three of these systems—HD 1388, HD 87359, and HD 104304—the properties of the imaged companion are consistent with the RV measurements, suggesting that these companions may be associated with the primary and the cause of the RV variation. For all 53 stellar systems, we derive differential magnitude limits (i.e., contrast curves) from the imaging. We extend this analysis to include upper limits on companion mass in systems without imaging detections. In 25 systems, we rule out companions with masses greater than 0.2 M _⊙, suggesting that the observed RV signals are caused by late-M dwarfs or substellar (potentially planetary) objects. On the other hand, the joint RV and imaging analysis almost entirely rules out planetary explanations of the RV signal for HD 19522 and suggests that the companion must have an angular separation below a few tenths of an arcsecond. This work highlights the importance of combined RV and imaging observations for characterizing the outer regions of nearby planetary systems.