Purpose To compare the agreement between whole-body (WB) magnetic resonance (MR) imaging, 18 F-FDG PET/CT, and skeletal survey (SS) in patients with multiple myeloma (MM) for diagnosis, initial staging, response evaluation, and early detection of complications. Methods This is a retrospective cohort study including MM patients who were diagnosed, treated, and followed in 2 institutions. These patients were studied with SS, WB-MR, and/or 18 F-FDG PET/CT. We studied bone lesions by anatomical locations and analyzed the concordance between SS and a tomographic technique (WB-MR or 18 F-FDG PET/CT) and between both tomographic techniques (WB-MR and PET/CT). Results Forty-four MM patients with a mean age of 62.6 years (range, 38–85 years) were included from January 2012 to February 2016. Whole-body MR and 18 F-FDG PET/CT found more lesions than SS in every location except in the skull. Concordance between WB-MR and 18 F-FDG PET/CT was either good or excellent in most of the locations and in plasmacytoma studies. However, WB-MR was better than 18 F-FDG PET/CT in the study of complications (medullar compression and vascular necrosis). Conclusions Our results suggest the study of MM patients should include WB-MR and/or 18 F-FDG PET/CT, whereas SS is only useful for the skull. Whole-body MR and 18 F-FDG PET/CT are complementary techniques, because both of them show good concordance in almost every location. It is still necessary to individualize the indication of each technique according to patient characteristics.

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