Craniopharyngiomas continue to present a challenge in clinical practice due to their heterogeneity and unpredictable adherence to vital neurovascular structures, particularly the hypothalamus. This results in different degrees of hypothalamus–pituitary axis dysfunction and a lack of uniform consensus and treatment guidelines regarding optimal management. MRI and CT are complementary techniques in the preoperative diagnostic phase, enabling the precise definition of craniopharyngioma size, shape, and consistency, as well as guiding classification into histopathological subtypes and topographical categories. Meanwhile, MRI plays a crucial role in the immediate postoperative period and follow-up stages by identifying treatment-related changes and residual tumors. This pictorial essay aims to provide an overview of the role of imaging in identifying variables indicative of the adherence degree to the hypothalamus, hypothalamic–pituitary dysfunction, the extent of surgical excision, and prognosis. For a more comprehensive assessment, we choose to distinguish the following two scenarios: (1) the initial diagnosis phase, where we primarily discuss the role of radiological variables predictive of adhesions to the surrounding neurovascular structures and axis dysfunction which may influence the choice of surgical resection; (2) the early post-treatment follow-up phase, where we discuss the interpretation of treatment-related changes that impact outcomes.
颅咽管瘤因其异质性及与重要神经血管结构（尤其是下丘脑）之间难以预测的粘连特性，在临床实践中仍面临挑战。这导致不同程度的下丘脑-垂体轴功能障碍，且在最佳治疗方案上缺乏统一共识与治疗指南。在术前诊断阶段，MRI与CT作为互补技术，能够精确界定颅咽管瘤的大小、形态与质地，并指导组织病理学亚型及解剖学分型的划分。同时，MRI在术后即刻及随访阶段具有关键作用，可识别治疗相关改变及残留肿瘤。本文旨在系统阐述影像学在评估以下指标中的作用：提示下丘脑粘连程度的变量、下丘脑-垂体功能障碍、手术切除范围及预后判断。为进行更全面的评估，我们区分以下两种临床场景：（1）初诊阶段，重点探讨影像学变量对预测肿瘤与周围神经血管结构粘连及轴系功能障碍的作用，这些因素可能影响手术切除策略的选择；（2）治疗后早期随访阶段，重点解析影响预后的治疗相关改变的影像学解读。
肿瘤(癌症)患者之家