Thyroid Imaging, Reporting and Data System (TIRADS)

Ultrasound features

Scoring is determined five categories. The higher the cumulative score, the higher the TR and the high the likelihood of malignancy.

One score is assigned from each of the following categories:

Margin: (choose one)

• smooth: 0 point

• ill-defined: 0 point

• lobulated/irregular: 2 points

• extra-thyroidal extension: 3 points

Composition: (choose one)

• cystic or completely cystic : 0 point

• spongiform : 0 point

• mixed cystic and solid: 1 point

• solid or almost completely solid: 2 points

Echogenicity: (choose one)

• anechoic: 0 points

• hyper- or isoechoic: 1 point

• hypoechoic: 2 points

• markedly hypoechoic: 3 points

Shape: (choose one)

• wider than tall: 0 points

• taller than wide: 3 points

Echogenic foci: (choose one or more)

• none: 0 points

• comet-tail artifact: 0 points

• macrocalcifications: 1 point

• peripheral/rim calcifications: 2 points

• microcalcification: 3 points

Scoring and classification

• TR1: 0 points (benign)

• TR2: 2 points (not suspicious)

• TR3: 3 points (mildly suspicious)

• TR4: 4-6 points (moderately suspicious)

• TR5: ≥7 points (highly suspicious)

Picture 2:

Well defined thin wall small ~4mm cystic nodule with comet tail artifact, normal surrounding thyroid tissue TR1.

Picture 3:

Well defined thin wall small ~4mm cystic nodule with comet tail artifact, normal surrounding thyroid tissue TR1.

Picture 4:

Well defined thin wall cystic nodule with internal echo and fluid debris level TR1.

Picture 1:

Well defined thin wall cystic nodule with internal debris and comet tail artifact.

Picture 6:

Picture 7:

Well defined complex mainly cystic nodule in Rt lobe TR2 ( solid part isoechoic without micro or macrocalcification).

Picture 8:

Well define smooth regular surface solid isoechoic to thyroid tissue nodule in Rt lobe low third without micro or macrocalcification TR3.

Picture 5:

Well defined thin wall 45*24 22mm cystic nodule TR1.

Picture 10:

Solid hypoechoic nodule with lobulated surface , micro and macrocalcification TR5.

Picture 11:

Small solid lobulated surface hypoechoic nodule with microcalcification TR5.

Picture 12:

Picture 9:

Well defined solid hypoechoic TR4 nodule.