Differentiating benign and malignant lesions of the osseous spine on imaging can be a daunting task for even the most seasoned radiologist. In addition to recognizing specific magnetic resonance imaging (MRI) features of osseous spinal tumors, radiologists can narrow the differential diagnosis by factoring in patient demographics and tumor location along the longitudinal extent of the spine as well as within a vertebra. Furthermore, familiarity with the current World Health Organization’s tumor designations and the incidence of specific tumors based upon patient age is important for the interpreting radiologist. This chapter will cover unique and sometimes overlapping MRI features of a variety of benign (venous malformation, aneurysmal bone cyst, osteochondroma, osteoid osteoma, osteoblastoma, bone island) and malignant (metastases, myeloma, leukemia, chordoma, chondrosarcoma, Ewing sarcoma, osteosarcoma) osseous spinal tumors.
