Recommendations for the use of magnetic resonance imaging (MRI) in multiple myeloma are presented in a consensus statement published online Jan. 20, 2015 in the Journal of Clinical Oncology. Meletios A. Dimopoulos, MD, from the National and Kapodistrian University of Athens School of Medicine in Greece, and colleagues used data published through March 2014 to develop recommendations for the value of MRI in multiple myeloma. Meletios A. Dimopoulos, M.D., from the National and Kapodistrian University of Athens School of Medicine in Greece, and colleagues used data published through March 2014 to develop recommendations for the value of MRI in multiple myeloma. The researchers note that compared with other radiographic methods, MRI has high sensitivity for the early detection of marrow infiltration by myeloma cells. MRI detects bone involvements earlier than the myeloma-related bone destruction and without radiation exposure. MRI is the gold standard for axial skeleton imaging, evaluation of painful lesions, and differentiation of benign and malignant osteoporotic vertebral fractures. MRI can detect spinal cord or nerve compression and presence of soft tissue masses and is recommended for solitary bone plasmacytoma workup. Additionally, according to the report, regarding smoldering or asymptomatic myeloma, all patients should undergo whole-body MRI (WB-MRI; or spine and pelvic MRI if WB-MRI is not available), and if they have less than one focal lesion of a diameter less than 5 mm, they should be considered to have symptomatic disease that requires therapy. In cases of equivocal small lesions, a second MRI should be performed after 3 to 6 months, and if there is progression on MRI, the patient should be treated as having symptomatic myeloma. MRI at diagnosis of symptomatic patients and after treatment (mainly after autologous stem-cell transplantation) provides prognostic information; however, to date, this does not change treatment selection.