Imaging methods assist in the pre-treatment planning of laryngeal and hypopharyngeal neoplasms, by better defining the local extension of infiltrating tumours and by detecting subclinical neck adenopathies. Imaging has also an important role in excluding or detecting distant metastasis. Furthermore, there is evidence that several imaging-derived parameters can be used as predictors of locoregional control after radiotherapy, and this independently from the TN classification. Such prognostic information is helpful in determining the relative value of surgery and radiation therapy, in selecting patients who may benefit from adjuvant treatment, and in identifying patients at high risk for recurrence to be followed up more closely.