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ACR (2017): TIRADS classification scheme and FNA guidance for thyroid nodules

ACR (2017): TIRADS classification scheme and FNA guidance for thyroid nodules
Composition Echogenicity Shape Margin Echogenic foci
Cystic or almost completely cystic 0 Anechoic 0 Wider-than-tall 0 Smooth 0 None or large comet-tail artifacts 0
Spongiform 0 Hyperechoic or isoechoic 1 Taller-than-wide 3 Ill-defined 0 Macrocalcifications 1
Mixed cystic and solid 1 Hypoechoic 2     Lobulated or irregular 2 Peripheral (rim) calcifications 2
Solid or almost completely solid 2 Very hypoechoic 3     Extrathyroidal extension 3 Punctate echogenic foci 3
 
  Points Malignancy risk (%) FNA biopsy threshold (mm)
TR1 0 0.3 No biopsy
TR2 2 1.5 No biopsy
TR3 3 4.8 25
TR4 4 to 6 9.1 15
TR5 7+ 35.0 10
ACR: American College of Radiology; TIRADS: Thyroid Imaging, Reporting and Data System; FNA: fine-needle aspiration.
References:
  1. Middleton WD, Teefey SA, Reading CC, et al. Multiinstitutional analysis of thyroid nodule risk stratification using the American College of Radiology Thyroid Imaging Reporting and Data System. AJR AM J Roentgenol 2017; 208:1331.

Original figure modified for this publication. From: 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. Table used with the permission of Elsevier Inc. All rights reserved.

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