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Introduction

Thyroid ultrasonography is currently the preferred imaging modality for the preoperative investigation of the patient with thyroid nodule. In order to improve consistency of reporting ultrasonographic findings, the TI-RADS system (Thyroid Imaging, Reporting and Data System) has been proposed by the American College of Radiology (ACR) in 2017.

 

The TI-RADS reporting system

The TI-RADS reporting system is based on 5 parameters-findings from diagnostic ultrasonography.

  1. Composition
  2. Echogenicity
  3. Shape (vertical vs. horizontal orientation)
  4. Margin and
  5. Echogenic foci

Interestingly, TI-RADS criteria do not encompass evaluation of regional lymph nodes.

 

Calculation of TI-RADS score

Sum points (designed for each of these characteristics) to calculate TI-RADS score, as follows:

TI-RADS 1

0 points

Benign lesion

No FNA

Cancer risk=0.3 %

 

TI-RADS 2

2 points

Not suspicious

No FNA

Cancer risk 1.5 %

 

TI-RADS 3

3 points

Mildly suspicious

1.5 cm: follow-up at 1, 3 and 5 yrs.

2.5 cm: FNA

Cancer risk 4.8 %

 

TI-RADS 4

4-6 points

Moderately suspicious

1 cm: follow up at 1,2,3 and 5 yrs.
>1.5 cm: FNA

Cancer risk 9 %

 

TI-RADS 5

≥7

Highly suspicious

0.5 cm: follow-up annually for 5 yrs.
> 1cm: FNA

Cancer risk 35 %

 

Practical usefulness of the TI-RADS system

The risk of underlying malignancy correlates with the TI-RADS category (see above).

The TI-RADS reporting system is useful in selecting optimal management of the patient with thyroid nodule: fine-needle aspiration cytology, follow-up ultrasonographic evaluation or no further action.

TI-RADS may reduce the number of thyroid nodules recommended for biopsy.

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