The traditional approach to diagnosis and staging in myeloma, based on haematologie and biochemical criteria, can be improved by inclusion of new forms of imaging. Standard radiographs have limited value but are still required because the majority of patients present with disease readily detected by this means. Also rapid extensive skeletal coverage is possible. Scintigraphy is limited by its poor sensitivity. CT is restricted to a region of interest but is however more accurate than DXA for demonstrating trabecular bone loss and density so that it emerges as valuable in the evaluation of therapy. MRI is currently the best choice for revealing marrow infiltration and, in ideal circumstances, the most sensible combination includes spine, pelvis and proximal femur MRI with skull, chest and rib X-rays. Furthermore MRI is finding a place in documenting prognosis when these individuals are treated.

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