Objective To compare the clinical value of in-phase and opposed-phase, apparent diffusion coefficient and diffusion-weighted imaging in diagnosis benign and malignant spinal lesion. Methods Patients with vertebral compression fractures caused by malignant tumor or benign lesion were selected, with 125 and 130 cases respectively. Routine sequence of MRI, DWI scan and double echo technique in the 3 D fast interference phase gradient echo was performed to acquire sequence IP/OP images. The DWI signal characteristic were also analyzed and the ADC value, SIR and SAR values were recorded and analyzed. Receiver operating characteristic curve (ROC) was performed to identify the optimal diagnosis indicator and value. Results DWI sequence in each groups is irregular, the ADC value in benign group is (2.35±0.42)×10-3mm2 / s and is (1.89±0.53)×10-3mm2 /s in malignant group, the difference is significant difference(t=4.859, P<0.001). The value of SIR in benign group is (0.65±0.23) and is (1.38±0.21) in malignant group, the difference is significant difference(t=-17.238, P<0.001). The value of SAR in benign group is (0.52±0.42) and is (0.19±0.12) in malignant group, the difference is significant difference (t=6.001, P<0.001). The ROC area for SAR, SIR and ADC is 65.1%, 72.4% and 96.5%, and the best diagnose value for ADC is 0.837. Conclusion DWI signal cannot be used for accurately diagnosis benign and malignant lesions of vertebral bodies, and ADC values and SIR and SAR values is of important value in diagnosis. ADC is the best diagnose value for benign and malignant lesions.