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MR, FDG-PET, and CT images from 8 patients with proven spinal findings of hyperplastic hematopoietic bone marrow were compared with those of 24 patients with spinal metastases. If a lesion was isointense to hyperintense to normal-appearing marrow on MR imaging or had a maximum standard uptake value of >3.6, the lesion was metastatic. A normal appearance on CT or bone scintigraphy excluded metastasis.