Multiple myeloma is the most common primary malignant bone neoplasm in adults and results in a wide range of radiographic abnormalities.

Multiple myeloma may simulate carcinomatosis radiologically, but is distinguishable from it by the absence of a known primary lesion and the presence of Bence-Jones proteins in the urine, an abnormal serum electrophoretic pattern with an excess of gamma globulin, and myeloma cells in a marrow biopsy sample.

Four main radiological patterns are recognized ⁹:

• type 1: solitary - similar in appearance to bone cysts
• type 2: multiple osteolytic lesions without marginal sclerosis
  • central
  • peripheral
• type 3: diffuse osteoporosis with generalized involvement
• type 4: diffuse osteosclerosis