🩺 TI-RADS Ultrasound Examples: Understanding Each Scoring Characteristic

Keywords: TI-RADS examples, thyroid ultrasound features, TI-RADS composition echogenicity shape margin foci, ACR TI-RADS scoring, thyroid nodule ultrasound examples

Introduction

When learning the ACR TI-RADS system, visual examples are key to understanding how each ultrasound feature contributes to the overall score.
Below are descriptions and image placeholders for each of the five TI-RADS characteristics with notes on how they affect scoring.

You can view the full scoring reference on the ACR TI-RADS Guidelines (Radiopaedia).

1️⃣ Composition

TI-RADS assigns 0–2 points based on how solid or cystic a nodule is.

TypeDescriptionPoints

• Cystic or almost completely cysticAnechoic, fluid-filled, thin walls. Usually benign colloid cyst.0

• Spongiform>50% small cystic spaces; classic benign pattern.0

• Mixed cystic and solidBoth fluid and soft-tissue components visible.1

• Solid or almost completely solidHypoechoic, dense tissue with minimal cystic change.2

2️⃣ Echogenicity

Echogenicity measures how bright or dark the nodule is compared to normal thyroid tissue.

TypeAppearancePoints

• AnechoicCompletely black (fluid-filled) — cystic lesions.0

• Isoechoic or Hyperechoic Same or brighter than thyroid parenchyma.1

• HypoechoicDarker than thyroid tissue, brighter than strap muscles.2

• Very HypoechoicEqual to or darker than adjacent strap muscles — more suspicious.3

3️⃣ Shape

Shape is one of the most critical indicators of malignancy.

ShapeAppearancePoints

1. Wider-than-tallThe nodule’s width (transverse) is greater than its height (AP). Usually benign.0

2. Taller-than-wideHeight exceeds width on transverse view — suggests invasive growth.3

4️⃣ Margins

Margins show how well-defined or irregular the edges of the nodule are.

Margin Type

• Smooth Clear, even contour. Benign.0

• Ill-defined Fuzzy edges; can occur in benign or malignant nodules.0

• Lobulated or Irregular Jagged, uneven outline suggesting infiltration.2

• Extrathyroidal Extension Nodule breaks capsule or extends into surrounding tissue.3

5️⃣ Echogenic Foci

These small internal echoes help identify calcifications or colloid artifacts.

Foci Type

• None or Large Comet-Tail Artifact Benign colloid reflection.0

• Macrocalcifications Large bright echoes with posterior shadowing.1

• Peripheral / Rim Calcifications Calcified rim around the nodule.2

• Punctate Echogenic FociTiny bright dots (microcalcifications) — more suspicious.3

Putting It All Together

Each characteristic contributes to a total TI-RADS score:

• 0 points → TR1 (benign)

• 2 points → TR2 (not suspicious)

• 3 points → TR3 (mildly suspicious)

• 4–6 points → TR4 (moderately suspicious)

• ≥7 points → TR5 (highly suspicious)

Once you’ve assessed your nodule, enter these findings into the TI-RADS Calculator to instantly view your total score, malignancy risk, and recommended follow-up interval.