MRI may be diagnostic of multiple myeloma.^[1]Findings on MRI suggestive of multiple myeloma include infiltration and replacement of the bone marrow.^[2][3] MRI is a more expensive test than an X-ray.

Magnetic resonance imaging (MRI) is more sensitive than simple X-ray in the detection of lytic lesions of multiple myeloma.^[2] The International Myeloma Working Group (IMWG) recently proposed revised imaging criteria for a diagnosis of multiple myeloma. The MRI criteria is the presence of greater than 1 focal lesion of at least 5mm in size. Of note, MRI is the most expensive of the imaging tests. X-rays may sometimes be a sufficient substitute for assessing for the presence of lytic lesions for patients who are symptomatic. However, X-rays carry a risk for radiation exposure, unlike MRI. Clinical judgment should be used when determining whether to order MRI or X-rays to assess for lytic lesions. MRI may supersede skeletal survey, especially when vertebral disease is suspected.^[2]

• Shown below is a series of MRI images of long bones involved in multiple myeloma. (Images courtesy of RadsWiki)

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  (Images courtesy of RadsWiki)
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  ([http://www.radswiki.net Images courtesy of RadsWiki

• Shown below is a series of MRI images in a multiple myeloma patient complaining of back pain.

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  (Images courtesy of RadsWiki)
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  (Images courtesy of RadsWiki)