Nasopharyngeal carcinoma (NPC) is a malignant tumor that shows distinct distributions into geographical and into well-defined high-risk ethnic groups. Radiation therapy is the mainstay of treatment, and imaging plays a central role in tumor mapping and post-treatment follow-up. Magnetic resonance imaging is better than computed tomography in demonstrating tumor extent, tumor recurrence, and postradiation complications. However, differentiating postradiation changes from tumor recurrence may be difficult using magnetic resonance imaging. Mucosal recurrence is best detected with endoscopy.