ACR TI-RADS

Points-based sonographic risk stratification of a thyroid nodule

Composition

Cystic or almost completely cystic (0)

Spongiform (0 — other features not scored)

Mixed cystic and solid (1)

Solid or almost completely solid (2)

Echogenicity

Hyperechoic or isoechoic (1)

Hypoechoic (2)

Very hypoechoic (3)

Shape

Wider than tall (0)

Taller than wide (3)

Margin

Smooth or ill-defined (0)

Lobulated or irregular (2)

Extrathyroidal extension (3)

Echogenic foci

None, or large comet-tail artefacts (0)

Macrocalcifications (1)

Peripheral (rim) calcifications (2)

Punctate echogenic foci (3)

Nodule size (largest diameter) cm

Select every feature and enter the nodule size to calculate

Evidence

Original publication

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. Defined the five-category points system, the TR1–TR5 levels, and the size thresholds for FNA and ultrasound follow-up by TR level used here.

Journal of the American College of Radiology, 2017

Open source

Guideline

Tessler FN, Middleton WD, Grant EG. Thyroid Imaging Reporting and Data System (TI-RADS): A User’s Guide. Practical application of the chart, including its footnotes: a spongiform nodule scores 0 with no points added for other features, "anechoic" applies only to cystic or almost completely cystic nodules, and so no correctly scored nodule totals exactly 1 point. TI-RADS does not apply to a nodule already selected for FNA on other grounds (e.g. a growing nodule, suspicious lymph nodes, or a patient with a relevant history) — those still warrant sampling regardless of the TR level or size. Size is the largest diameter on ultrasound. TR1 and TR2 nodules are not recommended for FNA at any size.

Radiology, 2018

Open source

Last reviewed: 2026-09

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