RadEssentialReading-room reference
ACR TI-RADS
Add points from all five feature categories (choose one per category, except echogenic foci where all present are summed). Points determine TR level; maximum diameter determines FNA or follow-up.
| Category | Feature → points |
|---|---|
| Composition | Cystic or almost completely cystic 0 · Spongiform 0 · Mixed cystic and solid 1 · Solid or almost completely solid 2 |
| Echogenicity | Anechoic 0 · Hyper- 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 · Extrathyroidal extension 3 |
| Echogenic foci | None or large comet-tail 0 · Macrocalcifications 1 · Peripheral (rim) 2 · Punctate echogenic foci 3 |
| Level | Points | FNA if | Follow-up if |
|---|---|---|---|
| TR1 | 0 · Benign | No FNA | None |
| TR2 | 2 · Not suspicious | No FNA | None |
| TR3 | 3 · Mildly suspicious | ≥2.5 cm | ≥1.5 cm |
| TR4 | 4–6 · Moderately suspicious | ≥1.5 cm | ≥1.0 cm |
| TR5 | ≥7 · Highly suspicious | ≥1.0 cm | ≥0.5 cm |
Score a nodule
Echogenic foci:
Points–Level–
Pearls
- Spongiform nodules score 0 for composition and are not scored further for echogenicity (they are always TR1 unless other features add points).
- Report no more than four nodules with highest TR levels; FNA at most two.
- Follow-up for TR3: 1, 3, 5 years. TR4: 1, 2, 3, 5 years. TR5: annually for 5 years. Growth = ≥20% and ≥2 mm increase in two dimensions, or ≥50% volume increase.
Sources
- Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017;14:587–595.PubMed ↗
Radessential summarizes published classification systems for practicing radiologists. Summaries are condensed; confirm details against the cited source before relying on them for patient care.