Abstract Background: Vertebral marrow lesions are commonly seen in older age groups of patients, due to a variety of causes ranging from infections, traumatic collapse, osteoporotic collapse, and neoplastic vertebral marrow changes. Aim of Study: The aim of this study was to evaluate the value of in and opposed phase MRI sequences in the charac-terization and differentiation between benign and malignant vertebral focal marrow lesions. Subjects and Methods: This prospective study was con-ducted at Ain Shams University hospitals. The study included 30 patients with focal lesions in the spine. The study period ranged from 6-9 months. Results: The sensitivity and specificity of Out of phase "Drop of signal" using contrast as a reference, the sensitivity was 95.2%, while specificity was 87.5%, AUC was 0.865 (95% CI: 0.69-0.96) with significant difference as p-value was (<0.05). Conclusion: Utilizing in phase and out of phase sequences greatly assist in diagnosing suspicious marrow lesions, hence this technique is greatly reducing the need for Intravenous contrast administration.