Regions can be saved inside TIFF files. Whenever you save an image containing a region as a TIFF file format, the region is also saved. Note, however, that the ability to save a region inside a TIFF file must be unlocked. This requires a Document Imaging or Medical Imaging toolkit.
When you save an image with a region as a CUR or ICO file, the pixels inside the region are considered to belong to the icon/cursor data. The pixels outside the region are considered transparent. If you save an image without a region as a CUR or ICO file, the whole image will be considered icon/cursor data. In this case, you will get a square icon or cursor.
If you save an image with a region as any other file format, the region will be lost. If you want to preserve the region, you can:
Medical Web Viewer .NET
.NET, Java, Android, and iOS/macOS Assemblies
C API/C++ Class Libraries