Unifying Concepts

Thyroid Imaging Reporting and Data System (TI-RADS)

Thyroid nodules are a frequent finding on neck sonography. Most nodules are benign; therefore, many nodules are biopsied to identify the small number that are malignant or require surgery for a definitive diagnosis. In 2012, the ACR convened committees to (1) provide recommendations for reporting incidental thyroid nodules, (2) develop a set of standard terms (lexicon) for ultrasound reporting, and (3) propose a TI-RADS on the basis of the lexicon.

Thyroid Imaging Reporting and Data System (TI-RADS)
The ultrasound features in the ACR TI-RADS are categorized as benign, minimally suspicious, moderately suspicious, or highly suspicious for malignancy. Points are given for all the ultrasound features in a nodule, with more suspicious features being awarded additional points.


  • Cystic or almost completely cystic:
  • Mixed cystic
  • Solid or almost


  • Anechoic: 0 points
  • Hyperechoic or isoechoic:
  • Hypoechoic: 2 points
  • Very hypoechoic: 3 points


  • Wider-than-tall: 0 points
  • Taller-than-wide: 3 points


  • Smooth: 0 points
  • Ill-defined: 0 points
  • Lobulated or irregular: 2 points
  • Extra-thyroidal extension: 3 points

Echogenic foci

  • None or large comet-tail artefacts: 0 points
  • Macrocalcifications: 1 point
  • Peripheral (rim) calcifications: 2 points
  • Punctate echogenic foci: 3 points

Based on their total points, nodules are then classed into five categories of suspicion for cancer:

  • 0 points, benign: No fine-needle aspiration (FNA).
  • 2 points, not suspicious: No FNA.
  • 3 points, mildly suspicious: FNA if >/= 2.5 cm; follow if >/= 1.5 cm.
  • 4 to 6 points, moderately suspicious: FNA if >/= 1.5 cm; follow if >/= 1 cm.
  • >/= 7 points, highly suspicious: FNA if >/= 1 cm; follow if >/= 0.5 cm.



  1. Vargas-Uricoechea H, Meza-Cabrera I, Herrera-Chaparro J. Concordance between the TIRADS ultrasound criteria and the BETHESDA cytology criteria on the nontoxic thyroid nodule. Thyroid Res. 2017 Feb 2;10:1. [Medline]
  2. Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC, Hammers LW, Hamper UM, Langer JE, Reading CC, Scoutt LM, Stavros AT. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017 May;14(5):587-595. [Medline]

Created Ene 02, 2018

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