Background: To retrospectively examine the usefulness of gray-scale reversal imaging of T2-weighted images (3D-T2R) in conjunction with other modes of 3D MRI for preoperative assessments in patients with glossopharyngeal neuralgia (GPN) due to neurovascular compression. Material/Methods: Imaging findings on 3D-T2R, constructive interference in steady state (CISS), and MRA were analyzed with reference to operative charts in 10 patients with GPN. Results: Offending vessels were associated with the posterior inferior cerebellar artery (PICA) in 9 of 10 patients (90%). Eight of the 10 patients (80%) had offending vessels located at the supraolivary fossette. Of those eight patients, six (75%) had a shift of the ipsilateral vertebral artery to the affected side. Five (42%) and seven (48%) contact points were associated with the root entry/exit zone and the peripheral nerve system segment, respectively. In six of nine contact points (67%), 3D-T2R demonstrated the pathomorphological features at the contact points better than CISS. Conclusions: The offending vessels were mostly associated with posterior inferior cerebellar arteries, were frequently located at the supraolivary fossette, and had attachments at the root entry/exit zone and at the peripheral segment of the glossopharyngeal nerve, which was well demonstrated on 3D-T2R.