Objective To explore the application value and imaging findings of X-ray and MRI in the diagnosis of multiple myeloma (MM). Methods The clinical data of 68 patients with multiple myeloma were retrospectively analyzed, including 54 cases of X-ray and 36 cases of MRI. The involving parts distribution of 68 MM patients and the MM imaging characteristics of two imaging examinations were analyzed, and the detection rate and diagnostic accuracy of MM by two examinations were compared. Results 54 cases examined by X-ray among 68 MM patients showed that there were 42 cases of bone destruction, 11 cases of pathological fractures, 5 cases of bone sclerosis, 13 cases of soft tissue mass and 10 cases of osteoporosis. 36 cases by MRI examination showed that there were diffuse type in 10 cases, focal type in 20 cases, diffuse focus type in 4 cases, and salt and pepper type in 8 cases. The detection rate and diagnostic coincidence rate of MRI were 100% and 97.2%, respectively, which were significantly higher than those of X-ray with 61.1% and 78.8%(χ2 =16.152 and 4.051, P<0.05). Conclusion MRI can detect early bone destruction and bone marrow infiltration of MM lesions. Compared with X-ray, MRI can improve the detection rate and coincidence rate, therefore it is worthy of clinical promotion and application.