The high signal intensity of fat on T1-weighted magnetic resonance images has limited the utility of gadopentetate dimeglumine in imaging of the extracranial head and neck. Enhancing lesions may be obscured either by proximity to fat or by chemical misregistration artifact. The authors evaluated the role of a gadolinium-enhanced fat suppression imaging technique in the detection of extracranial head and neck abnormalities in 29 patients. These studies were directly compared with conventional pre- and postcontrast T1- and T2-weighted SE sequences. In detecting and defining the extent of abnormalities, fat-suppressed images were superior to non-fat-suppressed gadolinium-enhanced T1-weighted images in the majority of cases (22 of 27 [81%]). Fat-suppressed images were particularly beneficial in the detection of perineural spread of tumor as well as in defining lesions situated within or adjacent to fat-containing areas such as the base of the skull. These findings demonstrate that fat suppression techniques in combination with gadolinium enhancement are of value in extracranial head and neck imaging and should replace conventional postcontrast T1-weighted SE imaging.