DWI is a powerful addition to the arsenal of MR imaging techniques for the detection of bone marrow tumor dissemination, improving sensitivity to involvement in a variety of tumor types (2). DWI increases confidence in monitoring treatment response and assisting in the differentiation of treatment related changes from tumor Distinguishing between benign and malignant etiologies of vertebral fracture with MRI is problematic, particularly if only one vertebra is affected. The value of DWI in discriminating between osteoporotic and metastatic vertebral fractures is controversial and by consensus insufficiently reliable (4-6). DWI is useful for differentiation of degenerative and infectious endplate abnormalities (7-9). Symptomatic degenerative vertebral endplate signal changes (Modic type 1) can be difficult to differentiate from acute spondylodiscitis using conventional MRI techniques. Several studies have shown that DWI adds value in differentiating degenerative and infectious endplate abnormalities. The role of MRS in identifying the painful disc and PET MR in localizing back pain will be discussed
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