Objective: This study was aimed to determine the accuracy of elevated choline metabolite in Magnetic Resonance Spectroscopy (MRS) at bone tumor to differentiate between benign and malignant according to their pathology result. Materials and Methods: A retrospective study of 40 samples consisted of benign and malignant bone tumor patients who met the inclusion criteria, who had MRS examination from January 2019 to January 2020. Elevated choline metabolite was used to differentiate between benign and malignant lesions based on their pathological result. From this study, we got sensitivity value, specificity value, PPV(positive predictive value), NPV(negative predictive value) and accuracy value. Results: The total number of patients were 40 who had bone tumor. The 11 benign tumors, consisted of 8 giant cell tumors (GCT), 1 aneurysmal bone cyst (ABC) and 2 abscesses on MRS the 7 of 8 GCTs and 1 ABC did not show elevated choline metabolite in MRS. One GCT and 2 abscesses showed elevated choline metabolite in their respective MRS. The 29 malignant cases consisted of 19 osteosarcomas, 2 chondrosarcomas, 2 plasmacytomas, 1 malignant GCT and 5 metastatic bone diseases. All but one case did not show elevated choline metabolite in their MRS and that was osteosarcoma. Conclusion: Elevated choline metabolite of proton MRS have higher sensitivity, specificity, PPV, NPV and accuracy to differentiate between benign and malignant bone tumor according to pathological result.