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The authors performed a retrospective data base search that queried neck CT reports with Neck Imaging Reporting and Data Systems scores of 2–4 from June 2014 to March 2018. The electronic medical records were reviewed to determine outcomes of clinical and radiologic follow-up, including symptoms, physical examination findings, pathologic correlation, and clinical notes within 3 months of imaging. A total of 255 cases all with NIRADS scores of 2 or 3 met the inclusion criteria. Fifty-nine patients (23%) demonstrated recurrence, and 21 patients (36%) had clinically occult recurrence. The median overall time to radiologically detected, clinically occult recurrence was 11.4 months from treatment completion. They conclude that imaging surveillance beyond the first posttreatment baseline study was critical for detecting clinically occult recurrent disease in patients with head and neck squamous cell carcinoma. More than one-third of all recurrences were seen in patients without clinical evidence of disease.