[en] To differentiate malignant vertebral compression fractures from benign fractures, as seen on spin-echo T1-wieghted, fast spin-echo T2-weighted, and fat-suppressed gadolinium-enhanced T1-weighted MR images. Thirty two benign (18 acute and 14 chronic) and 28 malignant vertebral collapses were studied in 54 patients aged between 15 and 78 (mean, 51) years. Malignant compression fractures involved only metastasis. We obtained sagittal and axial fast spin-echo T2-weighted images, and unenhanced and fat-suppressed gadolinium-enhanced T1-weighted images, and analyzed MR signal intensity, enhancement patterns, and morphologic changes including convex posterior cortex vs retropulsion of a bone fragment, focal vs diffuse paraspinal mass, and epidural mass. All cases of acute benign and malignant compression fractures showed low signal intensity within the vertebral body on T1-weighted images, and substantial contrast enhancement on fat-suppressed gadolinium-enhanced T1-weighted images. Acute benign and malignant compression fractures were distinguished on the basis of three signal intensity characteristics : hypointense band (acute benign cases 77% ; malignant cases 0%), diffuse low signal intensity(17% vs 86%) and involvement of pedicle (0% vs 75%). Fast spin-echo T2-weighted images played little role in distinguishing between the two. Three morphologic changes were suggestive of malignancy : convex posterior cortex (malignant cases 75% ; benign 0%), epidural mass (79% vs 5%), and focal paraspinal mass (57% vs 0%). Retropulsion of a bone fragment (benign cases 63% ; malignant cases 14%) was preferable for benignancy. In addition, thin diffuse paraspinal mass (benign cases 15% ; malignant cases 14%) was seen. The morphologic and signal intensity characteristics seen on T1-weighted images were useful for distinguishing benign and malignant vertebral compression fractures. Fast spin-echo T2-weighted and fat-suppressed gadolinium-enhanced T1-weighted images played little role in distinguishing between the two