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

SHAPE MARGIN
Taller-than-wide: 3 points Smooth: Ill-defined: Irregular: Lobulated: Extra-thyroid Extension:

• Should be assessed on a transverse image with

0 Points 0 Points 2 Points 2 Points 3 Points TR1
measurements parallel to sound beam for height 1 Point Benign
and perpendicular to sound beam for width.
No FNA
• Visual inspection is adequate for this.

• Anteroposterior (AP) length should be greater

than the transverse (TV) length.

AP
• Well defined, • Note the posteriorly • Jagged, spiculated, • Protrusions into • Obvious invasion =
smooth, curvilinear disappearing margin or sharp angles. adjacent tissues. malignancy.
TV
edge. (halo) in this image. TR2
• Can be present in • These may be single • Nodule will be seen to Not suspicious
• Assign zero points if part of, or all of the
2 Points
of multiple. extend beyond the
border is difficult to nodule. thyroid capsule . No FNA
discern from thyroid
parenchyma.

COMPOSITION Spongiform: 0 Points Mixed cystic and solid: 1 Point Solid: 2 Points

Total TR3
Mildly suspicious
TIRADS 3 Points
Cystic: 0 Points Composed predominantly (>50%) of small cystic spaces. Assign points for predominant solid Entirely or nearly entirely soft tissue FNA if ≥ 2.5cm
Cystic or almost completely
cystic nodule.
NB: Do not add further points for other categories. component. with only a few tiny cystic spaces. points Follow if ≥ 1.5cm

ECHOGENICITY
Hyperechoic: 1 Point Isoechoic: 1 Point . Hypoechoic: 2 Points Very Hypoechoic: 3 Points
. .

TR4
Increased echogenicity
4-6 Moderately Suspicious
Anechoic: 0 Points Similar echogenicity Decreased echogenicity Decreased echogenicity
Applies to cystic or almost relative to the thyroid relative to the thyroid relative to the thyroid relative to the adjacent Points FNA if ≥ 1.5cm
completely cystic nodules. tissue tissue tissue neck musculature Follow if ≥ 1cm

ECHOGENIC FOCI
Comet-tail artefacts: 0 Points Macrocalcifications: 1 Point Peripheral Calcificaitions: 2 Points Punctate Calcifications: 3 Points

TR5
7+ Highly Suspicious
Points FNA if ≥ 1cm
Follow if ≥ 0.5cm
V-shaped, >1 mm, in Calcifications with posterior Calcifications at periphery of the nodule. < 1 mm with no posterior
cystic components. acoustic shadowing Complete or incomplete along margin. acoustic shadowing

Pictures recreated from radiopedia.org and statdx.com with creative commons licence