Background: Spinal metastasis represent a global concern. It causes significant clinical problems in almost one fifth of cancer patients. It is associated with significant morbidity in almost 60% of cancer patients. Lytic metastasis is associated with greater risk of disability and associated pathological fracture than sclerotic lesions.

Aim and objectives: To calculate metastatic to vertebral body signal-ratio cut-off points in SWMR sequences for the differentiation between lytic and sclerotic spine bone lesions.

Subjects and methods: A prospective comparative study was conducted at the Diagnostic Radiology department, Suez Canal University hospitals, Ismailia, Egypt, including 84 participants.

Results: A value of (>1.18) is the best cut-off point to predict the sclerotic bony lesions in IM sequence, with sensitivity: 90.91% and specificity: 88.24%. Meanwhile, a value of (<1.45) was found to be the best cut-off point to predict the sclerotic bony lesions in PC sequence, with sensitivity: 90.91% and specificity: 88.24%. A value of (<1.18) was found to be the best cut-off point to predict the lytic bony lesions in IM sequence, with sensitivity:100% and specificity:92.31%. A value of (>1.45) was found to be the best cut-off point to predict the lytic bony lesions in PC sequences, with sensitivity: 100% and specificity: 92.31%.

Conclusion: we concluded that the MVR in both IM and PC MR sequences enables differentiation between lytic and sclerotic bony lesions with high accuracy, especially when added to the morphological interpretation of MRI signal intensity in PC and IM sequences.

Keywords: Metastasis to vertebral body ratio (MVR), Susceptibility, SWMR, CT