Structural neuroimaging plays a crucial role in the assessment of dementia. This chapter presents a radiological framework for evaluating clinical computed tomography or magnetic resonance imaging of the brain. It emphasizes the importance of recognizing atrophy patterns and utilizing standardized visual rating scales to assess brain atrophy. It also highlights the significance of identifying markers of vascular disease such as white matter hyperintensities, infarcts, microbleeds and perivascular spaces. It describes the characteristic imaging patterns observed in common dementia entities such as Alzheimer’s disease, frontotemporal dementia, and vascular dementia. By understanding the imaging patterns of different dementias, clinicians can make more accurate diagnoses and develop appropriate treatment plans.