ACR TI-RADS

A system introduced to standardize reporting of thyroid nodules on an ultrasound. Five ultrasound features are evaluated with points awarded to each feature.

  1. Composition
    • cystic or almost completely cystic – 0
    • spongiform – 0
    • mixed cystic and solid – 1
    • solid or almost completely solid – 2
  2. Echogenicity
    • anechoic – 0
    • hyperechoic or isoechoic – 1
    • hypoechoic – 2
    • very hypoechoic – 3
  3. Shape
    • wider-than-tall – 0
    • taller-than-wide – 3
  4. Margin
    • smooth – 0
    • ill-defined – 0
    • lobulated or irregular – 2
    • extra-thyroidal extension – 3
  5. 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