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1

ACR TI-RADS

ACR Thyroid Imaging Reporting and Data System

2

ACR Thyroid Imaging Reporting and Data System

Reporting system for thyroid nodules on US
- standardized scoring system for reports

3

What does ACR TI-RADS provide?

Provides users with recommendations for when to use fine needle aspiration or US follow-up on suspicious nodules, and when to safely leave alone nodules that are benign or not suspicious

4

How is the scoring determined for ACR TI-RADS?

From 5 categories of US findings
- the higher the cumulative score, the higher the TR level and likelihood of malignancy

5

What are the categories for ACR TI-RADS? (5)

1. Composition
2. Echogenicity
3. Shape
4. Margin
5. Echogenic foci

6

How is composition divided up? (4)

1. Cystic or almost completely cystic
- 0 points
2. Spongiform
- 0 points
3. Mixed cystic and solid
- 1 point
4. Solid or almost completely solid
- 2 points

7

How is echogenicity divided up? (4)

1. Anechoic
- 0 points
2. Hyperechoic or isoechoic
- 1 point
3. Hypoechoic
- 2 points
4. Very hypoechoic
- 3 points

8

How is shape divided up? (2)

1. Wider than it is tall
- 0 points
2. Taller than it is wide
- 3 points

9

How is margin divided up? (4)

1. Smooth
- 0 points
2. Ill defined
- 0 points
3. Lobulated/irregular
- 2 points
4. Extra-thyroidal extension (ETE)
- 3 points

10

How is echogenic foci divided? (pick all that apply) (4)

1. Non or large comet tail artifact
- 0 points
2. Macro-calcifications
- 1 point
3. Peripheral/rim calcifications
- 2 points
4. Punctate echogenic foci
- 3 points

11

0 points

Benign
- no FNA

12

2 points

Not suspicious
- no FNA

13

3 points

Mildly suspicious
- FNA

14

4-6 points

Moderately suspicious
- FNA

15

>7 points

Highly suspicious
- FNA

16

FNA

Fine needle aspiration

17

What is recommended for suspicious lesions?

Biopsies