Thyroid image reporting and data system

TIRADS

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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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THANK YOU