In recent years, two-dimensional metal halide perovskites have attracted increased attention for radiation detection and imaging. Their detection efficiencies are almost comparable to three-dimensional perovskites. Meanwhile, they demonstrate superior stability to three-dimensional perovskites. The pursuit of high-quality, phase-pure and lead-free two-dimensional metal halide perovskite materials and large-area fabrication capability for X-ray detectors are among the research hotspots. In this review, we first give a brief introduction of the crystallographic structure, optoelectronic characteristics and preparation methods of high-quality two-dimensional perovskites. In addition, we overview the general working principles of direct and indirect X-ray detection processes and the corresponding performance metrics from the perspective of detection and imaging. Furthermore, we give a comprehensive discussion on the recent advances in 2D perovskite X-ray detectors and imaging devices. Finally, we pinpoint several major obstacles of 2D X-ray detectors that should be overcome in the near future.