Background <p>MRI signal changes in the cerebellum are observed in multiple disorders including vascular diseases, neoplastic lesions, degenerative diseases, inflammatory disorders, metabolic diseases, infections, and trauma. In some diseases, cerebellar involvement is typical and sometimes isolated, while in other diseases cerebellar lesions are only observed occasionally in the presence of other typical extra-cerebellar abnormalities.</p> Methods <p>In this review, we will discuss the MRI characteristics of cerebellar lesions in adults observed in disorders with typical or frequent cerebellar involvement.</p> Results <p>Interpreting these cerebellar signal changes on MRI is essential to determine the underlying disorder. Assessing the lesion on MRI forms an essential part of diagnosis and follow-up, alongside patient’s history, clinical state and other radiological and non-radiological examinations.</p> Conclusion <p>The interpretation of cerebellar lesions on MRI depends on their exact localisation inside the cerebellum (e.g. uni- or bilateral lesions, involvement of the cerebellar peduncles, subcortical or cortical regions, or the deep cerebellar nuclei), signal changes on different MRI sequences, change of abnormalities over time, and the presence and characteristics of associated MRI lesions outside the cerebellum.</p>