Objective To summarize the CT and MRI features of patients with vertebral compression fractures and the main points for differential diagnosis of benign and malignant. Methods Fifty cases of patients with vertebral compression fractures treated in our hospital between Jan. 2010 and Mar.2016 were retrospectively analyzed. Based on the pathological results, the CT and MRI signs of patients were statistically analyzed, and the differences of CT and MRI signs between benign and malignant vertebral compression fractures were analyzed. Results Of the 50 patients with vertebral compression fractures, 18 cases were benign and 32 cases were malignant. The main CT and MRI findings included bilateral sign, inflation sign, bone destruction, paravertebral soft tissue shadow, periosteal reactions, spokes and wheel-shaped high density sign. There were no significant differences in the incidence of bilateral sign, inflation sign, bone destruction, paravertebral soft tissue shadow and periosteal reactions between benign and malignant patients (P>0.05). 77.8% (14/18) of patients with benign vertebral compression fracture had spoke and wheel-shaped high density sign. The percentage was significantly higher than that of patients with malignant vertebral compression fractures (P<0.05). Conclusion Bilateral sign, inflation sign, bone destruction, paravertebral soft tissue shadow, periosteal reactions, spokes and wheel-shaped high density sign are common CT and MRI signs. Spokes and wheel-shaped high density sign can be used as a key sign for differential diagnosis of benign and malignant vertebral compression fractures, which is conductive to judging the nature of vertebral fractures and can provide reference for formulation of treatment plan.