Although diagnostic evaluation of the larynx and hypopharynx is primarily done with endoscopy, cross-sectional imaging plays an indispensable complementary role because it enables one to evaluate the deep structures of the larynx. Both CT and MR imaging can provide images with excellent detail of the larynx and hypopharynx. CT, the standard modality for more than a decade, has recently become further enhanced by the introduction of helical scanning, which enables much faster image acquisition and multiplanar or three-dimensional image reconstruction. Nonetheless, the role of CT is being increasingly challenged by MR imaging. Many investigators already consider MR imaging to be the method of choice for imaging of the larynx and hypopharynx because it provides superior soft tissue contrast. Some relative drawbacks of MR imaging still persist, however, including long acquisition periods, motion artifacts, claustrophobia, and lack of availability. Therefore, both CT and MR imaging are currently used widely, with preferences being based mainly on local and individual factors.

The complementary role of endoscopy and cross-sectional imaging demands a close, regular interdisciplinary cooperation. The radiologist who performs and interprets CT and MR imaging studies of the larynx and hypopharynx must not only be familiar with the normal and pathologic anatomy, but also with the clinical relevance and therapeutic implications of the imaging findings. This is of particular importance in the context of pretherapeutic and posttherapeutic evaluation of squamous cell carcinoma, which constitutes the most important indication to perform CT and MR imaging. This article reviews the current role of imaging of the larynx and hypopharynx with an emphasis on neoplastic disease.