Multiple Myeloma. A. A lateral radiograph of the lumbar spine shows diffuse osteopenia and a pathologic compression fracture of the L1 vertebral body (arrow). B. A midsagittal T2-weighted MR image of the same patient obtained several months later reveals extensive marrow infiltration (low signal intensity within the marrow of multiple vertebral bodies) and numerous vertebral body compression fractures. Significant central canal stenosis has resulted from retropulsion of vertebral fragments from the pathologic fractures. Radiographs in patients with early multiple myeloma may appear normal or may exhibit only osteopenia resembling senile osteoporosis. Nuclear medicine bone scans are also frequently insensitive to multiple myeloma changes often resulting in false negative results. (Images courtesy of Lindsay J. Rowe, Newcastle, Australia).