Mycetoma remains a common pathology in tropical areas. Diagnosis, based on mycology and pathology is still frequently late and treatment often leaves severe functional disorders. Medical imaging is indispensable to evaluate disease spread to bone tissue. Plain radiograms usually show cortical erosion, defects with sclerosing margins, and bone thickening. CT is the most sensitive technique to detect bony involvement. CT and MR imaging, when available, are the most accurate techniques for determining disease extension in both bones and soft tissues.