Background: The sellar and suprasellar regions represent anatomically complex and clinically significant areas due to their proximity to critical neurovascular structures and the diversity of potential pathological entities. Magnetic Resonance Imaging (MRI) serves as the diagnostic modality of choice, offering superior soft tissue contrast and multiplanar capabilities. This study was undertaken to evaluate and categorize sellar and suprasellar space-occupying lesions based on their MRI characteristics. Methods: A retrospective observational study was conducted over one year at the Department of Radiodiagnosis and Imaging Sciences, Jorhat Medical College and Hospital, Assam. Eighteen patients with confirmed sellar or suprasellar space-occupying lesions underwent MRI evaluation using a 1.5 Tesla GE scanner. Imaging protocols included non-contrast and contrast-enhanced T1-weighted, T2-weighted, FLAIR, DWI, and MR spectroscopy sequences. Lesions were assessed based on location, signal intensity, enhancement patterns, and mass effect. Clinical history and, wherever available, histopathological results were correlated. Results: The study population consisted of 8 males and 10 females, with an age range of 9 to 67 years (mean age: 37 years). The most prevalent presenting complaint was visual disturbance. Among the 18 patients, the most frequently encountered lesion was pituitary macroadenoma (n=6, 33.3%), predominantly involving the intrasellar region with suprasellar extension and cavernous sinus encasement. Craniopharyngiomas (n=4, 22.2%) exhibited mixed cystic-solid morphology with hyperintense cystic components, and solid enhancing nodules. Intracranial aneurysms (n=4, 22.2%) were characterized by rounded masses with low T2 signal intensities, with confirmation by CT angiography. Meningiomas (n=3, 16.6%) demonstrated classical imaging features including dural tail sign, and preserved cerebrospinal fluid-vascular cleft. A single case of astrocytoma (n=1, 5.5%) involved the suprasellar region with cystic and solid components peripheral enhancement on contrast administration, consistent with a pilocytic subtype. Conclusion: MRI plays an indispensable role in the assessment of sellar and suprasellar lesions facilitating accurate diagnosis and management planning. The study underscores the importance of recognizing specific imaging signatures to differentiate among common pathologies, minimize diagnostic errors, and guide therapeutic strategies.

Suprasellar mass, sellar lesions, pituitary macroadenoma, craniopharyngioma, aneurysm