Multiple myeloma (MM) is the second most common adult hematologic malignancy, and early intervention can improve survival in asymptomatic high-risk patients. Imaging plays a crucial role in diagnosis and follow-up, particularly in detecting bone and bone marrow lesions. Low-dose whole-body computed tomography (LDWBCT) is the preferred initial assessment method, while dual-energy CT (DECT) is a developing technique with potential for detecting non-lytic marrow infiltration and evaluating treatment response. Magnetic resonance imaging (MRI) is more sensitive and specific than 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for detecting small focal lesions and diffuse marrow infiltration. However, FDG-PET/CT is recommended for follow-up due to its ability to distinguish between active and inactive disease. Diffusion-weighted MRI (DWI) has emerged as a new technique for quantitative assessment of disease burden and therapy response. This review provides an updated overview of MM imaging, including indications, advantages, limitations, and recommended reporting for each technique. It also covers differential diagnosis, controversies, and future directions, such as PET-MRI and artificial intelligence.Multiple myeloma (MM) is the second most common adult hematologic malignancy, and early intervention can improve survival in asymptomatic high-risk patients. Imaging plays a crucial role in diagnosis and follow-up, particularly in detecting bone and bone marrow lesions. Low-dose whole-body computed tomography (LDWBCT) is the preferred initial assessment method, while dual-energy CT (DECT) is a developing technique with potential for detecting non-lytic marrow infiltration and evaluating treatment response. Magnetic resonance imaging (MRI) is more sensitive and specific than 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for detecting small focal lesions and diffuse marrow infiltration. However, FDG-PET/CT is recommended for follow-up due to its ability to distinguish between active and inactive disease. Diffusion-weighted MRI (DWI) has emerged as a new technique for quantitative assessment of disease burden and therapy response. This review provides an updated overview of MM imaging, including indications, advantages, limitations, and recommended reporting for each technique. It also covers differential diagnosis, controversies, and future directions, such as PET-MRI and artificial intelligence.