Thyroid Imaging Reporting and Data System (TI-RADS PDF.pdf

Thyroid Imaging Reporting and Data System (TI-RADS) Prepared By: Dr.Mahabad M.Ziad Naqishbandi ABHS (radiology) (TI-RADS) of the American College of Radiology (ACR) was designed in 2017 with the intent to: Thyroid Imaging Reporting and Data System (TIRADS) decrease biopsies of benign nodules improve...

Thyroid Imaging Reporting and Data System (TI-RADS) Prepared By: Dr.Mahabad M.Ziad Naqishbandi ABHS (radiology) (TI-RADS) of the American College of Radiology (ACR) was designed in 2017 with the intent to: Thyroid Imaging Reporting and Data System (TIRADS) decrease biopsies of benign nodules improve overall diagnostic accuracy. The five ultrasound features of thyroid nodules used in TI-RADS are as follows: Composition Echogenicity Shape Margin punctate echogenic foci Each item is given point. The points are added from all categories to determine the TI-RADS level, each with a recommendation. Nodules smaller than 5 mm do not need any followup, even if they are TI-RADS 5. The cutoff point of 2.5 cm for fine needle aspiration (FNA) in mildly suspicious TR3 lesions is based on studies showing that thyroid carcinomas don’t have a decreased survival until they reach this threshold value. The risk of malignancy is: TI-RAD Malignancy risk TR1: 0.3% TR2: 1.5% TR3: 4.8% TR4: 9.1% TR5: 35% Composition Cystic lesions or lesions that are almost completely cystic are benign and no further points will be added (TI-RADS 1). This is also true for spongiform lesions which are always benign and no further characterization using ultrasound features is needed. Here a typical cyst. No further evaluation is needed. Spongiform nodules Spongiform nodules have a sponge-like appearance, with at least 50% cystic composition of tiny cystic parts. No further characterization is needed. Mixed cystic/solid lesions In mixed cystic/solid lesions the amount of cystic and solid parts is not important. This lesion gets 1 point for the mixed cystic/solid composition. Solid lesions The lesion in A is almost completely solid. While there are small cystic parts, it is not considered a spongiform nodule, because the small cystic parts are far less than 50% of the total nodule. The lesion in B is completely solid. In solid nodules at least 95% of the nodule should be solid. Echogenicity 1 2 3 An anechoic lesion should be completely black, which means that it is cystic. No further characterization is needed. Hyperechoic and isoechoic lesions both get 1 point, so for the score it does not matter The echogenicity is compared with normal thyroid parenchyma. Hypoechoic means that a lesion is more hypoechoic than normal thyroid parenchyma. If the echogenicity cannot be assed, for example because of calcifications, 1 point is given for the echogenicity. A very hypoechoic lesion is more hypoechoic than normal muscle. Notice that the tumor is more hypoechoic in comparison to the strap muscles (arrows). Very hypoechoic , i.e. 3 points in TI-RADS. Shape The shape should be assesed in the axial plane. A taller-than-wide shape is a strong predictor of malignancy, and therefore gets 3 points. The margin is often best assessed on the anterior side: the margin is completely smooth Margin Ill-defined: the margins of the nodule cannot be clearly defined from the thyroid parenchyma. This is a benign feature and should be distinguished from the irregular margin. Lobulated or irregular: margins are lobulated, spiculated, irregular or angulated.. Extra-thyroidal extension: difficult to analyze on ultrasound, there should be clear invasion of nearby structures. Bulging of the nodule in nearby structures is not enough Margin Ill-defined nodule. Notice how only some small parts of the border of the nodule can be defined (arrow). Most of its margin is indistinct from the thyroid parenchyma. (0 points in TI-RADS). A nodule with irregular angulated margins. (2 points in TI-RADS). Lobulated margin The image shows an irregular lobulated margin of the anterior surface. (2 points in TI-RADS). There is a nodule which has exophytic growth with compression of the nearby structures. Echogenic foci Comet tail artefact Echogenic foci is the only category where multiple options are possible and you have to choose all that apply. Points will be added to the total score. This means that when both punctate echogenic foci and rim calcifications are present, the TI-RADS points are 3 + 2 = 5 points 0 points is given for: No echogenic foci. Large comet tail artefacts > 1 mm (figure). Macrocalcification This nodule has large macrocalcifications with acoustic shadowing. (TI-RADS: 1 point). Rim calcification Peripheral rim calcifications can be complete or incomplete. (TI-RADS: 2 points). Punctate echogenic foci are also known as microcalcifications. They are a strong predictor of malignancy and therefore get 3 points. Microcalcifications The ACR lexicon further defined this category, because in the normal thyroid there also may be echogenic foci visible. Punctate echogenic should be called in the situation where they are obvious and only visible within the nodule. Microcalcifications Small comet tail artifacts with a length less than 1mm are also included in this category. (TI-RADS: 3 points). TI-RADS – Thyroid Imaging Reporting and Data System Thank you