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Posttreatment follow-up imaging of head and neck cancer is challenging because of the anatomic complexity of the head and neck region and the operations and posttreatment effects of radiation and chemotherapy that mimic recurrent disease. The Neck Imaging Reporting and Data System (NI-RADS) provides standardized terminology, report structure, and evaluation categories to convey the degree of suspicion of recurrence in the interpretation of imaging studies. This meta-analysis found NI-RADS 3 (high suspicion) has a high diagnostic performance for detecting clinically significant recurrence.