Pictorial Review of TI-RADS Scoring System for Thyroid Nodules
Dr. Michael Njunge (FY2), Dr. Chris Sparks (ST3 Radiology), Dr. Tara Barton (Consultant Radiologist) mnjunge@doctor.org.uk
Total
TIRADS
points
1 Point
2 Points
3 Points
4-6
Points
7+
Points
TR3
Mildly suspicious
FNA if ≥ 2.5cm
Follow if ≥ 1.5cm
TR2
Not suspicious
No FNA
TR1
Benign
No FNA
TR4
Moderately Suspicious
FNA if ≥ 1.5cm
Follow if ≥ 1cm
TR5
Highly Suspicious
FNA if ≥ 1cm
Follow if ≥ 0.5cm
Pictures recreated from radiopedia.org and statdx.com with creative commons licence
SHAPE MARGIN
AP
TV
Extra-thyroid Extension:
3 Points
•Obvious invasion =
malignancy.
•Nodule will be seen to
extend beyond the
thyroid capsule .
Lobulated:
2 Points
•Protrusions into
adjacent tissues.
•These may be single
of multiple.
Ill-defined:
0 Points Irregular:
2 Points
•Jagged, spiculated,
or sharp angles.
•Can be present in
part of, or all of the
nodule.
Smooth:
0 Points
•Well defined,
smooth, curvilinear
edge.
SHAPE
Taller-than-wide: 3 points
•Should be assessed on a transverse image with
measurements parallel to sound beam for height
and perpendicular to sound beam for width.
•Visual inspection is adequate for this.
•Anteroposterior (AP) length should be greater
than the transverse (TV) length.
Smooth:
0 Points
•Note the posteriorly
disappearing margin
(halo) in this image.
•Assign zero points if
border is difficult to
discern from thyroid
parenchyma.
COMPOSITION
ECHOGENIC FOCI
ECHOGENICITY
Cystic: 0 Points
Cystic or almost completely
cystic nodule.
Mixed cystic and solid: 1 Point Solid: 2 Points
Composed predominantly (>50%) of small cystic spaces.
NB: Do not add further points for other categories.
Anechoic: 0 Points
Applies to cystic or almost
completely cystic nodules.
Hyperechoic: 1 Point
Increased echogenicity
relative to the thyroid
tissue
Isoechoic: 1 Point .
Similar echogenicity
relative to the thyroid
tissue
Hypoechoic: 2 Points
.
Decreased echogenicity
relative to the thyroid
tissue
Very Hypoechoic: 3 Points
.
Decreased echogenicity
relative to the adjacent
neck musculature
Assign points for predominant solid
component. Entirely or nearly entirely soft tissue
with only a few tiny cystic spaces.
Spongiform: 0 Points
Comet-tail artefacts: 0 Points
V-shaped, >1 mm, in
cystic components.
Macrocalcifications: 1 Point
Calcifications with posterior
acoustic shadowing
Peripheral Calcificaitions: 2 Points
Calcifications at periphery of the nodule.
Complete or incomplete along margin.
Punctate Calcifications: 3 Points
< 1 mm with no posterior
acoustic shadowing