A system introduced to standardize reporting of thyroid nodules on an ultrasound. Five ultrasound features are evaluated with points awarded to each feature.
- Composition
- cystic or almost completely cystic – 0
- spongiform – 0
- mixed cystic and solid – 1
- solid or almost completely solid – 2
- Echogenicity
- anechoic – 0
- hyperechoic or isoechoic – 1
- hypoechoic – 2
- very hypoechoic – 3
- Shape
- wider-than-tall – 0
- taller-than-wide – 3
- Margin
- smooth – 0
- ill-defined – 0
- lobulated or irregular – 2
- extra-thyroidal extension – 3
- Echogenic foci
- none or large comet-tail artefacts – 0
- macrocalcifications – 1
- peripheral (rim) calcifications – 2
- punctate echogenic foci – 3
Classification
TI-RADS 1
- 0 points
- benign
- no FNA
TI-RADS 2
- 2 points
- not suspicious
- no FNA
TI-RADS 3
- 3 points
- mildly suspicious
- > 2.5 cm size needs FNA
- follow up after 1, 3 and 5 years
TI-RADS 4
- 4 – 6 points
- moderately suspicious
- > 1.5 cm size needs FNA
- follow up after 1, 2, 3 and 5 years
TI-RADS 5
- 7 or more points
- highly suspicious
- > 1 cm needs FNA
- follow up annually for 5 years
- 35% risk of malignancy