NI-RADS (Head & Neck Surveillance)

ACR NI-RADS (2018 white paper)

ACR NI-RADS risk-stratifies post-treatment head and neck surveillance imaging: the primary site and the neck nodes are each categorized 0–4 for suspicion of recurrence, with linked management from routine surveillance to biopsy or treatment.

Also searched as: head and neck · recurrence · pet · ct · mri · acr · cancer

Prior/baseline comparison imaging

Pathologically proven or unequivocal radiologic/clinical progression

If confirmed recurrence already exists, the examination is NI-RADS 4 regardless of other features.

Primary site — most suspicious morphologic finding (CT/MRI)

Primary site — FDG uptake

Neck nodes — most suspicious finding

Neck nodes — FDG uptake

Information

Incomplete input

Please provide: Availability of prior comparison imaging.

How this tool works

The Neck Imaging Reporting and Data System (ACR NI-RADS, 2018) standardizes interpretation of contrast-enhanced CT or MRI, with or without FDG-PET, performed after definitive treatment of head and neck cancer. Expected post-treatment change — non-mass-like soft-tissue distortion, post-radiation edema, diffuse radiation mucositis — is NI-RADS 1. Focal superficial (mucosal) abnormalities are 2a and merit direct visual inspection, whereas ill-defined deep-tissue abnormalities or mild FDG uptake are 2b and merit short-interval follow-up imaging or PET. New or enlarging discrete masses with intense enhancement, intense focal FDG uptake, or nodes with new necrosis or gross extranodal extension are NI-RADS 3 and should be biopsied. Category 0 covers examinations awaiting prior comparison imaging, and category 4 denotes proven recurrence. When structural imaging and PET are discordant, the lower of the two adjacent categories is assigned. The overall examination category is the higher of the primary-site and neck categories.

References

Implemented from the cited published sources. Educational use only; confirm against current guidelines before clinical use.

Clinical questions that use this

Vetting guides that reach for this tool.

Head and neck cancer — staging and post-treatment surveillance

Related calculators

Same subspecialty, overlapping subject matter.

ARWMC Scale (Wahlund White Matter Changes)Fazekas Scale (White Matter Lesions)Fisher & Modified Fisher Grade (SAH)Intracerebral Hemorrhage Volume (ABC/2)Knosp Classification (Pituitary Adenoma)Koos Classification (Vestibular Schwannoma)