Forty patients with disorders of the larynx or hypopharynx were studied with magnetic resonance (MR) imaging. Axial, coronal, and sagittal sections, 4 mm thick, were obtained. Twenty-eight of the patients underwent computed tomography (CT) scanning; 17 underwent surgery, and specimens were obtained for organ sectioning. Correlation was made between these three studies as well as with clinical history, physical examination, and endoscopic photography. In 13 patients who underwent all three studies, the depiction of cartilage invasion, adenopathy, and intraorgan and extraorgan spread of disease was compared. MR consistently showed superior soft-tissue definition and extent of disease compared with CT. Neither CT nor MR was able to depict histologic detail or microscopic spread of disease. Both studies were also less effective in the postoperative or postirradiated neck. The use of direct coronal and sagittal imaging planes on MR allowed the visualization of intrinsic laryngeal musculature, which was important in the recognition of subtle tumor extension. For these reasons, surface coil MR imaging is currently the imaging study of choice at our institution for disorders of the larynx and hypopharynx.