Abstract: Multiple myeloma has unique manifestations of bone disease, mainly presenting as osteolytic lesions and diffuse osteoporosis as a result of over-activation of osteoclasts and suppression of osteoblasts. The severity of myeloma bone disease is negatively correlated with quality of life and survival. Plain X ray has low sensitivity to contour destructive bone lesions. Whole body low dose CT does not differentiate active foci from tranquil ones. Functional imaging including diffuse weighted imaging-magnetic resonance imaging (DWI-MRI) and positron emission tomography/computed tomography (PET/CT) are more sensitive in evaluation of comprehensive tumor load and detection of early disease. Moreover, minimal residue disease detected by DWI-MRI or PET/CT is a complement of flow cytometry and predicts progressive disease in patients achieving complete response. In this article, we summarized the role of imaging methods in evaluating myeloma bone disease and tumor load.