Over 20% of people have a pituitary lesion on a magnetic resonance imaging (MRI) study. Most commonly these are small pituitary neuroendocrine tumours (PitNETs) or Rathke’s cleft cysts. The prevalence of a clinically significant PitNET is 1 in 1000 people. Clinical decision making is optimised when undertaken in the setting of a multi-disciplinary team (MDT). Radiology is an integral component of an MDT, and an experienced neuroradiologist is essential for both diagnosis and follow-up of these lesions. However, the endocrinologist should ensure they are familiar with the neuroradiology techniques and develop their own expertise in the interpretation of the images, particular as some general radiology practices lack a dedicated neuroradiology specialist to report them. MRI is the mainstay of pituitary neuroimaging and was first used clinically in the 1980s. A standard set of sequences for a pituitary MRI scan include T1 non-contrast coronal and sagittal, T2 coronal, T1 post-contrast coronal and sagittal plus dynamic sequences when looking for functional microadenomas. The slice thickness should be ≤2mm. Features to be noted include: size/volume, suprasellar extension and relationship to the optic apparatus, tumour invasion, internal tumour changes and any characteristics which might distinguish a PitNET from other sellar/parasellar masses. Newer sequences such as the contrast-enhanced 3D-T2-weighted SPACE sequence show promise to improve detection of small corticotroph PitNETs. Functional positron emission tomography (PET) scans using tracers such as 11C-methionine and 68Ga-DOTA-CRH have improved the detection of secretory microadenomas. MRI is preferred for radiological follow-up of sellar and parasellar masses. There are no Endocrine Society guidelines on the frequency of post-operative radiological follow-up, though some other national societies have formulated these. Volumetric growth rate across the first 3 years has been shown to predict need for re-intervention for non-functioning PitNETs. Macroadenomas probably need lifelong follow-up, while stable microadenomas can be safely discharged.