Fig. 7. Patterns of multiple myeloma.

A-H. Axial inverted DWI (b-value = 900 s mm²) (A, C, E, G, I). Corresponding to the ADC maps (B, D, F, H).

A, B. Normal adult bone marrow.

C, D. Focal pattern. Images demonstrate focal bone lesions greater than 5 mm (arrows), which have a higher signal intensity, with high b-value, than the muscle and background marrow, as well as a higher ADC value than the background bone marrow.

E, F. Diffuse pattern. A high b-value image (E) shows a more diffuse, higher signal intensity than muscle, and the corresponding ADC map (F) shows a higher signal intensity than that of the normal bone marrow.

G, H. Focal diffuse pattern. DWI (G) shows focal bone lesions (arrows) with a higher signal intensity than the muscle. However, the background marrow has a higher signal intensity than that of the muscle, and the corresponding ADC (H) shows a higher signal intensity than that of the normal bone marrow.

I, J. Micronodular patterns. DWI (I) and T1-weighted Dixon fat-only images (J) show multiple small nodular signal changes (≤ 5 mm).

K, L. The images show a paramedullary soft-tissue disease with direct continuity with the bone marrow lesion (arrows).

M, N. The images show an extramedullary disease that is not in continuity with bone marrow disease (arrows).

ADC = apparent diffusion coefficient, DWI = diffusion-weighted image