This paper presents examples of non-neoplastic lesions of the spine that produce focal or diffuse signal alterations on MR images, and that may, therefore, be confused with metastases or primary neoplasms. Examples include endplate changes associated with degenerative disk disease, hemispherical spondylosclerosis, osteoporotic compression fractures, Paget's disease, focal and diffuse fatty infiltration, osteomyelitis, and changes associated with various arthritides. Distinguishing signal intensity characteristics on T1 and T2 weighted images and distinctive morphology are emphasized.