Objective To analyze the CT and MRI manifestations of suprasellar Rathke's cysts (RCC) and cystic craniopharyngiomas (CCP), summarize the imaging manifestations with diagnostic value for differential diagnosis, and thereby improve the accuracy of preoperative imaging diagnosis. Methods We retrospectively reviewed 10 cases of suprasellar RCC and 14 cases of suprasellar CCP, confirmed through surgery and pathology at West China Hospital, Sichuan University from January 2018 to November 2024. We analyzed their CT and MRI characteristics and performed ROC analysis on imaging features with a P<0.05 to evaluate the sensitivity and specificity of each feature in diagnosis. Results The sensitivity of the differential diagnosis for CT calcification was 100% and the specificity was 92.9%. The sensitivity of the differential diagnosis for MRI with uneven cyst fluid signal was 80% and the specificity was 64.3%. The sensitivity of the differential diagnosis for uneven cyst wall thickness was 90% and the specificity was 85.7%. The sensitivity of the differential diagnosis for cyst wall enhancement was 70% and the specificity was 92.9%. The sensitivity of the differential diagnosis for enhanced intracystic mural nodules was 100% and the specificity was 57.1%. The sensitivity of the differential diagnosis for blurred optic chiasm was 80% and the specificity was 92.9%. Conclusion The imaging features of calcification on CT, inhomogeneous capsule wall thickness on MRI, uneven capsule wall thickness, inhomogeneous cyst wall enhancement, enhancement of wall nodule within the cyst, and blurred optic chiasm can be used to create a differential diagnosis flowchart. Preoperative imaging can help differentiate between the two conditions, thereby assisting clinicians in selecting the appropriate surgical approach