Objective: Vertebral compression fractures are common in the elderly, particularly in those who are osteoporotic.The reasons for vertebral compression fractures in the elderly include benign fractures and pathological fractures, and the former is usually due to osteoporosis, but the latter is mostly due to vertebral metastasis.The vertebral column is the region of the skeleton most frequently affected by metastatic diseases in cancer patients.So how to differentiate benign vertebral compression fractures from the malignant becomes very important for the clinic,especially in elderly patients who have histories of malignancy.The aim of this study was to evaluate the role of 18F-fluorodeoxyglucose (18F-FDG) in diagnosing benign vertebral compression fractures in the elderly.Methods: The criteria for enrolled patient was as following: there were no abnormal appearances to be found on PET/CT images except for the vertebra, and the involved vertebra were in the shapes of wedge displayed on sagittal slices of PET/CT images, and no destruction of bony cortexes or adjacent soft masses were found; There were no evidences of trauma histories on spines within three month.The clinical follow-up time of all patients was no less than 6 six months, and final diagnosis of benign vertebral compression fractures were verified by relative clinical data and follow-up.18F-FDG PET/CT imaging were performed in 24 patients with vertebral compression fractures.The regions of interest (ROIs) were drew on transaxial images around the involved vertebra for the aim of semi-quantitative analysis, and the average standardized uptake values (SUVavg) were used to quantify the uptake of FDG in the corresponding vertebra.Results: Total 47 vertebra among 24 cases were involved in the study, and SUVavg of all involved vertebra ranged between 0.6 and 2.3, only one patient was found to having high accumulation of FDG in adjacent inflammation soft-tissue around L3 (SUVavg=3.5).Among 15 patients with MRI results, 20 vertebra in 10 patients were diagnosed of benign compression fractures, but 17 vertebra in 5 patients were diagnosed of metastasis.Conclusions: 18F-FDG PET plays an important role in diagnosing benign vertebral compression fractures, especially in elderly patients with histories of malignant tumors.