Objective:In this study, the basic information, symptoms, endoscopy and imaging of patients with nasopharyngeal skull base necrosis and tumor recurrence after radiotherapy of nasopharyngeal carcinoma were compared to explore the differences between the two, so as to provide basis for the diagnosis of patients and facilitate the evaluation and formulation of accurate treatment plans.Methods: 38 cases of nasopharyngeal carcinoma patients with nasopharyngeal skull base destruction after radiotherapy from January 2012 to April 2022 were divided into necrosis group and recurrence group according to pathological results. The gender composition, age of onset, secondary radiotherapy, time of onset, endoscopic nasopharyngeal necrosis and new biological conditions, CT and MRI findings of the two groups were compared.Results: There were significant differences between the two groups in gender composition, onset time, secondary radiotherapy, nasal odor, endoscopic nasopharyngeal lesions, CT manifestations of bone destruction, nasopharyngeal soft tissue enhancement, and MRI manifestations of soft tissue and bone marrow T2 and enhancement (P < 0.05).Conclusion: Through comprehensive analysis of the gender, onset time, clinical symptoms, nasal endoscopic findings, CT and MRI findings of the patients with nasopharyngeal skull base destruction after nasopharyngeal carcinoma radiotherapy, we can preliminarily distinguish nasopharyngeal skull base necrosis and tumor recurrence after nasopharyngeal carcinoma radiotherapy, which is helpful for clinical development of accurate treatment plan.