Multimodality imaging, including MRI, bone scintigraphy, and FDG PET/CT, was performed to evaluate a 49-year-old man who had right hip and lower limb pain for 4 months because possible malignancy was suspected. All 3 modalities showed obvious Paget disease of the lumbar spine. However, less impressive increased activity was also noted on FDG PET/CT images. Subsequent laboratory tests and pathology examination leads to diagnosis of multiple myeloma. Our case further confirms the notion that it is insufficient to focus on the most obvious and unintentionally overlook the less impressive findings in interpreting nuclear medicine images.