TIRADS Calculator for Thyroid Nodules
Spongiform: Composed predominantly (>50%) of small cystic spaces. No further points are added for other categories.
Mixed cystic and solid: Assign points for predominant solid component.
Anechoic: Applies to cystic or almost completely cystic nodules.
Hyperechoic/isoechoic/hypoechoic: Compared to adjacent parenchyma.
Very hypoechoic: More hypoechoic than strap muscles.
Shape should be assessed on a transverse image with measurements parallel to sound beam for height and perpendicular to sound beam for width.
Lobulated: Protrusions into adjacent parenchyma.
Irregular: Jagged, spiculated, or sharp angles.
Extrathyroidal extension: Obvious invasion of adjacent soft tissue or vascular structures.
Large comet-tail artifacts: V-shaped, >1 mm, in cystic components.
Macrocalcifications: Cause acoustic shadowing.
Peripheral calcifications: Complete or incomplete along margin.
Punctate echogenic foci: Nonshadowing, may have small comet-tail artifacts.
• TR1 Benign (0 pts)
• TR2 Not Suspicious (2 pts)
• TR3 Mildly Suspicious (3 pts)
• TR4 Moderately Suspicious (4-6 pts)
• TR5 Highly Suspicious (≥7 pts)
FNA no more than 2 nodules with the highest TIRADS point scores at a time.
Follow no more than 4 nodules with the highest TIRADS point scores at a time.
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: 587-595
Grant EG, Tessler FN, Hoang JK et al. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J Am Coll Radiol. 2015; 12: 1272-1279
Some benign patterns of Hashimoto's thyroiditis are not included in the TIRADS classification (e.g. "white knight" = uniformly hyperechoic nodule, "giraffe hide" = hyperechoic areas separated by hypoechoic bands).
Virmani V, Hammond I. Sonographic patterns of benign thyroid nodules: verification at our institution. AJR Am J Roentgenol 2011; 196:891-895