Figure 1.

Paired images from patients illustrating different imaging modalities. Image pairs (A,B) and (E,F) are patients with active multiple myeloma. Image pair (C,D) is a patient with smoldering multiple myeloma. (A) Frontal pelvis radiograph demonstrates diffuse osteopenia with a dominant destructive osteolytic myelomatous deposit at the left supra-acetabular region as well as multiple smaller subtle lucent foci of disease. (B) Coronal reformat CT of the pelvis from a whole-body CT multiple myeloma protocol again demonstrates the dominant destructive left supra-acetabular lesion as well as multiple additional foci of smaller osteolytic myelomatous disease throughout the imaged osseous structures. Many of the smaller lesions identified on CT were occult on the comparison radiographs. (C) Coronal reformat CT of the pelvis from a whole-body CT multiple myeloma protocol demonstrates diffuse heterogeneity of the bone marrow including regions of mixed lucency and slightly increased density with a representative lucent focus at the superior aspect of the right iliac bone. (D) Coronal T1-weighted non-fat saturated image from a whole-body MRI multiple myeloma protocol demonstrates a diffusely heterogeneous appearance of the bone marrow without evidence for macroscopic myelomatous disease. (E) Coronal T1-weighted non-fat saturated image from a whole-body MRI multiple myeloma protocol demonstrates a diffuse micronodular pattern of myelomatous disease, also commonly referred to as a variegated or salt-and-pepper appearance. (F) Coronal STIR image from a whole-body MRI multiple myeloma protocol demonstrates diffuse heterogeneity of the bone marrow with a dominant hyperintense right hemisacral lesion compatible with macroscopic myelomatous disease.