"if negative..."
"if CT negative..."
"if CT negative..."
"low-density submucosal/mucosal oedema (post-radiation oedema)"
"residual abnormal, new, or enlarging node(s), without new suspicious morphology (necrosis, extra-nodal extension)"
"enlarging node(s), with new necrosis or gross extranodal extension"
"Neck Imaging and Reporting and Data System (NI-RADS) is a lexicon and risk classification proposed by the American College of Radiology for reporting surveillance imaging of treated head and neck cancer. The terminology and categories may be applied to any head and neck malignancy (e.g. squamous cell carcinoma, mucoepidermoid carcinoma), and are intended to direct clinical management."
"This article reflects revisions published in the 2018 ACR white paper 1."
"Standardised reporting systems (e.g. BI-RADS, LI-RADS) are designed to improve communication between radiologists, referring clinicians, and/or patients, in areas of high clinical impact. In head and neck oncology, imaging is primarily used to monitor for disease recurrence following initial treatment. Thus, NI-RADS was developed to address whether or not imaging demonstrates evidence of tumour recurrence 2."
"Standardised reporting systems (e.g. BI-RADS, LI-RADS) are designed to improve communication between radiologists, referring clinicians, and/or patients, in areas of high clinical impact. In head and neck oncology, imaging is primarily used to monitor for disease recurrence following initial treatment. Thus, NI-RADS was developed to address whether or not imaging demonstrates evidence of tumour recurrence 2."
"The primary purpose of NI-RADS is to provide a framework for consistent reporting across readers and institutions. The framework consists of a standardised terminology and 4-tier classification, used to support direct management recommendations."
"NI-RADS is intended for contrast-enhanced cross-sectional imaging (i.e. CT or MRI), with or without FDG-PET-CT. While protocols for the timing of post-treatment imaging vary by institution, surveillance may begin as early as 8-12 weeks post-treatment 1."
"As there is no universal algorithm to direct timing/frequency of post-treatment imaging, NI-RADS advocates following institution-defined protocols in order to maintain consistency."
"NI-RADS suggests timing for surveillance imaging in head and neck squamous cell carcinomas:"
"NI-RADS 0: incomplete (prior imaging unavailable, but will be obtained)"
"NI-RADS 1: no evidence of recurrence"
"NI-RADS 2: low suspicion of recurrence"
"NI-RADS 3: high suspicion of recurrence ("can and should be biopsied")"
"NI-RADS 4: known recurrence"
"NI-RADS 0 refers to a new baseline study in which prior comparison imaging is unavailable at the time of interpretation and will be procured in the future. If prior imaging cannot be obtained, the NI-RADS category and management decisions should be assigned based on available information."
"NI-RADS 0 refers to a new baseline study in which prior comparison imaging is unavailable at the time of interpretation and will be procured in the future. If prior imaging cannot be obtained, the NI-RADS category and management decisions should be assigned based on available information."
"NI-RADS 4 refers to recurrence that is either proven pathologically or considered definite by imaging or clinical criteria."
"NI-RADS 1"
"NI-RADS 2"
"NI-RADS 3"
"NI-RADS 1"
"NI-RADS 2"
"NI-RADS 3"
"When there is discordance between CT and PET, the NI-RADS category should be assigned to the lower of the adjacent scores. For example, when there is ill-defined deep soft tissue without any FDG uptake, the NI-RADS category is 1. When there is focal intense FDG uptake without discrete mass, the NI-RADS category is 2. When there is a discrete enhancing mass with at most moderate FDG uptake, the NI-RADS category is 2. Only when CT and PET are concordant for highly suspicious features is the NI-RADS category 3 assigned."
"When there is discordance between CT and PET, the NI-RADS category should be assigned to the lower of the adjacent scores. For example, when there is ill-defined deep soft tissue without any FDG uptake, the NI-RADS category is 1. When there is focal intense FDG uptake without discrete mass, the NI-RADS category is 2. When there is a discrete enhancing mass with at most moderate FDG uptake, the NI-RADS category is 2. Only when CT and PET are concordant for highly suspicious features is the NI-RADS category 3 assigned."
"When there is discordance between CT and PET, the NI-RADS category should be assigned to the lower of the adjacent scores. For example, when there is ill-defined deep soft tissue without any FDG uptake, the NI-RADS category is 1. When there is focal intense FDG uptake without discrete mass, the NI-RADS category is 2. When there is a discrete enhancing mass with at most moderate FDG uptake, the NI-RADS category is 2. Only when CT and PET are concordant for highly suspicious features is the NI-RADS category 3 assigned."
"When there is discordance between CT and PET, the NI-RADS category should be assigned to the lower of the adjacent scores. For example, when there is ill-defined deep soft tissue without any FDG uptake, the NI-RADS category is 1. When there is focal intense FDG uptake without discrete mass, the NI-RADS category is 2. When there is a discrete enhancing mass with at most moderate FDG uptake, the NI-RADS category is 2. Only when CT and PET are concordant for highly suspicious features is the NI-RADS category 3 assigned."
"When there is discordance between CT and PET, the NI-RADS category should be assigned to the lower of the adjacent scores. For example, when there is ill-defined deep soft tissue without any FDG uptake, the NI-RADS category is 1. When there is focal intense FDG uptake without discrete mass, the NI-RADS category is 2. When there is a discrete enhancing mass with at most moderate FDG uptake, the NI-RADS category is 2. Only when CT and PET are concordant for highly suspicious features is the NI-RADS category 3 assigned."
"Each NI-RADS category carries a management recommendation. Considering the most prudent next step in management is helpful when deciding on a NI-RADS category for borderline findings. These recommendations are as follows:"
"Each NI-RADS category carries a management recommendation. Considering the most prudent next step in management is helpful when deciding on a NI-RADS category for borderline findings. These recommendations are as follows:"
"NI-RADS 0: obtain prior imaging examinations, after which a score can be assigned in an addendum"
"NI-RADS 1: continue routine surveillance"
"NI-RADS 2a: direct visual inspection of area of concern"
"NI-RADS 2b: additional PET or short-interval (3 month) follow-up with CT"
"NI-RADS 3: biopsy (image-guided or clinical) area of concern"
"NI-RADS 4: treatment of disease (with or without biopsy)"
"NI-RADS demonstrates good risk stratification. Rates of persistent or recurrent head and neck squamous cell carcinoma (as demonstrated on biopsy, subsequent imaging, or physical examination) have been reported by NI-RADS category 3,4:"
"NI-RADS demonstrates good risk stratification. Rates of persistent or recurrent head and neck squamous cell carcinoma (as demonstrated on biopsy, subsequent imaging, or physical examination) have been reported by NI-RADS category 3,4:"
"NI-RADS 1: 4%"
"NI-RADS 2: 15-17%"
"NI-RADS 3: 59%"
"RADS (Reporting and Data Systems)"
"NI-RADS interactive calculator - Rad At Hand"
"if negative..."
"if PET-CT negative... no need for further surveillance"
"if CT negative..."
"if CT negative..."
"no nodal enlargement or new suspicious morphology (necrosis, extra-nodal extension)"
"residual abnormal, new, or enlarging node(s), without new suspicious morphology (necrosis, extra-nodal extension)"
Expected headings
"Background"
"Imaging frequency"
"Category descriptors"
"Imaging findings"
"CT"
"PET"
"Management recommendations"
"Performance"
"External links"