The authors report abnormal Tc-99m sestamibi (MIBI) and TI-201 uptake in a 62-year-old patient with histologically and biochemically proved myeloma. TI-201 imaging was undertaken for tumor evaluation, and 3 days later a Tc-99m MIBI study showed diffuse and focal marrow uptake with focal skull lesions, whereas TI-201 did not show skull lesions. After treatment, follow-up Tc-99m MIBI whole-body imaging was performed and the marrow uptake was decreased.