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