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Thyroid Imaging Reporting and Data System (TIRADS)

Hisham AlKhatib, M.D.Consultant Radiologist

• In 2017, a white paper was released by the ACR committee on thyroid imaging with a standardised scoring system, with guidance on fine needle aspiration (FNA) and follow-up.

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• in 2009 Horvath et al proposed an evaluation system for TNs called TI-RADS (Thyroid Imaging Reporting and Data System), similar to the Breast Imaging Reporting and Data System (BI-RADS)

• In 2011, Kwak et al , complemented this classification adding one subtype

• Similar to BIRADS category, sonographic TIRADS classification is as follows

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Sonographically suspicious criteria for malignancy

• • Hypoechogenicity

• • Microcalcifications

• • Partially cystic nodule with eccentric location of the fluid portion and lobulation of the solid component

• • Irregular margins

• • Perinodular thyroid parenchyma invasion

• • Taller-than-wide shape

• • Intranodular vascularity

(TIRADS)

• TIRADS 1: normal thyroid gland

• TIRADS 2: benign lesions

• TIRADS 3: probably benign lesions

• TIRADS 4: suspicious lesions (subclassified as 4a, 4b, and later 4c with increasing risk of malignancy)

• TIRADS 5: probably malignant lesions (more than 80% risk of malignancy)

• TIRADS 6: biopsy proven malignancy

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TIRADS 1 category

• normal thyroid gland

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TIRADS 2 category

• avascular anechoic lesion with echogenic specks (colloid type I)

• vascular heteroechoic non- expansile, non-encapsulated nodules with peripheral halo (colloid type II)

• isoechoic or heteroechoic, non-encapsulated, expansile vascular nodules (colloid type III)

• These conditions have 0% risk of malignancy.

• Score of zero

TI-RADS 2: simple thyroid cyst.

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TI-RADS 2: solid nodule with central cyst

TI-RADS 2: nodule with homogeneous peripheral calcification.

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TI-RADS 2: spongiform nodule

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TIRADS 3 category

• probably benign lesions

TI-RADS 3: hyperechoic nodule

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TIRADS 4 category

• 4a – Undetermined nodules (5-10% risk of malignancy)

– Score of 1.

• 4b – Suspicious nodules (10-50% risk of malignancy)

– Score of 2.

• 4c – Highly suspicious nodules (50-85% risk of malignancy)

– Score of 3-4

TIRADS 4 and 5 categories

• solid component

– high stiffness of nodule on elastography if available

• markedly hypoechoic nodule

• microlobulations or irregular margins

• microcalcifications

• taller-than-wider shape

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Subclassificaiton

• TIRADS 4a: one suspicious feature

• TIRADS 4b: two suspicious features

• TIRADS 4c: three/four suspicious features

• TIRADS 5: all five suspicious features

TI-RADS4a: markedly hypoechoic nodule, of normal shape and abnormal vascularity. Score of 1

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TI-RADS 4b: nodule with microcalcifications and poorly defined irregular margins. Score of 2

TI-RADS 4b: nodule with two sonographically suspicious criteria for malignancy: hypoechogenicity and internal vascularity

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TI-RADS 4c: nodule with microcalcifications, irregular borders and taller than wide shape (greater in its anteroposterior diameter than in its transverse diameter). Score of 3.

TI-RADS 4c: hypoechoic nodule of irregular margins with a taller than wide shape. Score of 3.

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TIRADS 5 category

• solid component

– high stiffness of nodule on elastography if available

• markedly hypoechoic nodule

• microlobulations or irregular margins

• microcalcifications

• taller-than-wider shape

TI-RADS 5: hypoechogenic nodule with microcalcifications and poorly defined margins, with perinodular tissue invasion (arrow). Taller than wide shape

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suspicious hypoechoic lymph node, with round shape and abnormal vascularity. Overall score of 6 for

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