Aim: Acute sinusitis in children can occasionally lead to orbital or intracranial complications as a result of contiguous spread of infection. We aimed to evaluate the magnetic resonance imaging (MRI) features and distribution patterns of these complications in pediatric patients with acute paranasal sinusitis. Methods: This retrospective analytical study included 32 pediatric patients (aged 0-18 years) who underwent contrast-enhanced brain and diffusion-weighted MRI between May 2017 and April 2024 for suspected sinusitis-related complications. Demographic data (age, sex), sinus involvement, and MRI findings were evaluated. Statistical analyses were performed using chi-square tests and Student’s t-tests; a p-value of <0.05 was considered significant. All MR images were reviewed by a pediatric neuroradiologist with ten years of experience. Results: Among the 32 pediatric patients, the most frequent complication was subperiosteal abscess (n=15, 46.9%), followed by preseptal cellulitis (n=13, 40.6%). Less common findings included epidural empyema (n=2, 6.3%), venous sinus thrombosis (n=1, 3.1%), cerebral abscess (n=1, 3.1%), and cerebral infarction (n=1, 3.1%). Involvement of the ethmoid and maxillary sinuses was significantly more frequent in younger children (p<0.01), whereas involvement of the sphenoid and frontal sinuses was more common in older patients (p=0.03). When evaluated by complication type, orbital complications predominated in younger patients, while intracranial complications were more frequent in older age groups (p=0.02). This indicates a statistically significant age-related shift in the patterns of sinus involvement and distribution of complications. Conclusion: Magnetic resonance imaging plays a critical role in detecting and characterizing sinusitis-related complications in pediatric patients. Beyond confirming a diagnosis, it provides valuable information for clinical decision-making and surgical planning. Recognizing age-dependent sinus involvement patterns helps predict the potential routes and severity of the spread of complications, ultimately improving outcomes and reducing morbidity.