Objective Meta-analysis was performed to evaluate the accuracy of MRI-based differential diagnosis of be-nign and malignant vertebral compression fracture(VCF)and to estimate its clinical value.Methods A comprehensive search was conducted in Chinese and English databases for studies published before December 2023 on the differential diag-nosis of benign and malignant VCFs using imaging histology,and the data were screened according to the criteria for ranking the literature,and quality assessment and data extraction were performed.Meta-analysis was performed on the extracted data using Stata software,combined sensitivity and specificity data were calculated,a composite subject work characteristic curve(SROC)was plotted,regression and subgroup analyses were performed on the sources of heterogeneity,and publication bias was examined using Deek's method.Results Eight studies that met the criteria were included in the analysis,with a com-bined sensitivity and specificity of 0.92(95%CI=0.86-0.95)and 0.95(95%CI=0.90-0.98),respectively,and plotting the SROC curve revealed an area under the curve(AUC)=0.98(95%CI=0.96-0.99).The use of cross-validation,the inclusion of clinical features and imaging sequences were all sources of heterogeneity.Conclusion Imaging histological models can effectively differentiate and diagnose benign and malignant VCF with good clinical application.