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Notochordal lesions span a spectrum of disease ranging from benign notochordal remnant (ecchordosis physaliphora) to low-grade to aggressively malignant. Benign notochordal remnant cannot be reliably distinguished from low-grade chordoma as they may have overlapping imaging features. Repeat imaging, beginning at 6-month intervals, is a more clinically relevant method for evaluating the malignant potential of these lesions.