The Role of Neck Imaging Reporting and Data System (NI-RADS) in the Management of Head and Neck Cancers.

This review evaluates the current evidence on the use of the Neck Imaging Reporting and Data System (NI-RADS) for the surveillance and early detection of recurrent head and neck cancers. NI-RADS offers a standardized, structured framework specifically tailored for post-treatment imaging, aiding radiologists in differentiating between residual tumors, scar tissue, and post-surgical changes. NI-RADS demonstrated a strong diagnostic performance across multiple studies, with high sensitivity and specificity reported in detecting recurrent tumors at primary and neck sites. Despite these strengths, limitations persist, including a high frequency of indeterminate results and variability in di-agnostic concordance across imaging modalities (computed tomography, magnetic resonance imaging (MRI), positron emission tomography(PET)). The review also highlights the NI-RADS's reproducibility, showing high inter- and intra-reader agreements across different imaging techniques, although some modality-specific differences were observed. While it demonstrates strong diagnostic performance and good reproducibility across imaging modalities, attention is required to address indeterminate imaging findings and the limitations of modality-specific variations. Future studies should focus on integrating advanced imaging characteristics, such as diffusion-weighted imaging and PET/MRI fusion techniques, to further enhance NI-RADS's diagnostic accuracy. Continuous efforts to refine NI-RADS protocols and imaging interpretations will ensure more consistent detection of recurrences, ultimately improving clinical outcomes in head and neck cancer management.