The inflammatory changes of paranasal sinus (PNS) mucosa or sinusitis are among the most common inflammatory diseases of the human body. Diagnosis of sinusitis is based on clinical findings. Sinusitis could be clinically presented as acute and chronic entities which these can only be differentiated from each other on the basis of the duration of the patient’s symptoms and signs, and the imaging cannot be useful for this differentiation.The major role of imaging for the evaluation of PNS is determination of the main sinuses involved, the extension of the involvement, chronic sinusitis complications such as mucocele, polyposis and retention cysts, interventions (functional endoscopic sinus surgery, FESS) and acute sinusitis related complications such as intracranial abscesses and osteomyelitis. As a result, whenever the response of the patient’s symptoms and signs to correct and sufficient medical treatment is not desirable, imaging modalities could be practical and gain their importance.The main imaging modalities which are applicable for PNS evaluation consist of magnetic resonance imaging (MRI) and computed tomography Scan (CT Scan), each with its own specific applications. MRI is useful for intracranial complications of acute sinusitis such as brain abscesses and CT Scan is useful for acute sinusitis related bony structure lesions such as erosions, lysis and osteomyelitis. Both CT Scan and MRI can be useful for the diagnosis of mucocele, polyposis and retention cyst which are the main complications of chronic sinusitis.CT Scanning in coronal sections is very useful for the evaluation of the osteomeatal complex (OMC). It is the imaging modality of choice before performing FESS. Evaluation after performing FESS can also be done by means of PNS CT Scanning, for instance the degree of obstruction recanalisation and FESS-related complications such as orbital hematoma.Common PNS anatomic variations such as nasal septum deviation, pneumatized middle turbinate (concha bullosa), bulla ethmoidalis and extension of anterior ethmoidal cells within the lacrimal bone (agger nasi cell) can also easily be evaluated by this imaging modality, which are considered as major anatomic causes of OMC obstruction and obstruction-related chronic sinusitis.In conclusion, the diagnosis of sinusitis is based on clinical findings. Imaging is not for the diagnosis of sinusitis and it is only applicable for sinusitis and FESS-related complications. MRI is the best imaging modality for intracranial complications of acute sinusitis. Both MRI and CT Scanning almost have the same diagnostic accuracy for chronic sinusitis-related complications.