As has happened in all facets of neuroimaging, cross-sectional imaging has dramatically changed our approach and understanding of the anatomy and pathology of paranasal sinuses. We have moved away from plain film radiographs to modern high-resolution sinus computerized tomography (CT) and magnetic resonance imaging (MRI) that helps us better depict underlying normal anatomy and evaluate pathology. Recent advances in PET/CT imaging have introduced a physiologic aspect to anatomical imaging and holds promise to better stage and restage head and neck tumors. In this article, we describe the various imaging techniques, concerns, advantages and disadvantages of the individual techniques, and provide an overview of the various pathologies involving the paranasal sinuses. Anat Rec, 291:1564–1572, 2008. © 2008 Wiley-Liss, Inc.