PURPOSE: To compare normal vertebrae with vertebrae with neoplastic compression fractures by means of opposed-phase (OP) and in-phase (IP) gradient-echo (GRE) imaging. MATERIALS AND METHODS: On OP and IP T1-W GRE images (obtained at 1.5 T with the fast low-angle shot (FLASH) technique) of dual-phase chemical shift sequences, we compared the signal intensity ratios (SIRs) of normal and compression-fractured vertebrae in 108 patients. Dual-phase chemical shift sequences were measured in three groups of vertebral bone marrow in terms of the relative SIR in OP and IP images: group 1: normal vertebrae (N = 30 with 90 vertebrae); group 2: non-neoplastic compression-fractured vertebrae (N = 58 with 73 vertebrae); and group 3: neoplastic compression-fractured vertebrae (N = 20 with 27 vertebrae). The presence of compressed vertebrae was ascertained based on the consensus of two experienced radiologists. The mean SIRs among the three groups were compared by means of the Tukey-Kramer test. RESULTS: The mean SIRs of the three groups (group 1: 0.46 +/- 0.14; group 2: 0.63 +/- 0.21; and group 3: 1.02 +/- 0.11) were significantly different according to the Tukey-Kramer test (P < 0.01). CONCLUSION: OP and IP T1-W GRE MRI of vertebral SI abnormalities can help predict the nature of compression fractures.