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  • Kevin M. Rice, MD

TI-RADS 5 • Thyroid Papillary Cancer

Updated: Jul 26, 2021

Thyroid Nodule • Xray of the Week 2017 • Week #40

What is the TI-RADS Score of this nodule? What would you do next?

Thyroid Papillary Cancer

Figure 1: Thyroid Ultrasound. TI-RADS Scoring

Here is how I scored it:

Composition: Solid or almost completely solid - 2 points

Echogenicity: Hypoechoic - 2 points

Shape: Taller-than-wide - 3 points

Margin: Lobulated or irregular - 2 points

Echogenic Foci: Punctate echogenic foci - 3 points


TIRADS 5 - Highly Suspicious, Needs FNA.

Biopsy was performed and it showed thyroid papillary cancer.

Diagram of retrograde flow in Ophthalmic artery

Figure 2: Thyroid Ultrasound. Arrows showing the punctate echogenic foci.

The ACR Thyroid Imaging Reporting and Data System (TI-RADS) is a system that can take the guess work out of reading thyroid ultrasounds. The goal is to improve quality and decrease unnecessary biopsies.


Figure 3: ACR TI-RADS System


2. Grant, E G, Tessler, FN, Hoang, JK, Langer, JE, Beland, MD, Berland, LL, Cronan JJ, Desser, TS, Frates, MC, Hamper, UM, Middleton, WD, Reading, CC, Scoutt, LM, Stavros, AT and Teefy, SA. (2015). Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. Journal of the American College of Radiology,12(12), 1272-1279.

3. Franklin N. Tessler, MD, CMCorrespondence information about the author MD, CM Franklin N. TesslerEmail the author MD, CM Franklin N. Tessler, William D. Middleton, MD, Edward G. Grant, MD, Jenny K. Hoang, MBBS, Lincoln L. Berland, MD, Sharlene A. Teefey, MD, John J. Cronan, MD, Michael D. Beland, MD, Terry S. Desser, MD, Mary C. Frates, MD, Lynwood W. Hammers, DO, Ulrike M. Hamper, MD, Jill E. Langer, MD, Carl C. Reading, MD, Leslie M. Scoutt, MD, A. Thomas Stavros, MD ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee.

Kevin M. Rice, MD

Kevin Rice, MD serves as the Chair of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is the Chief Compliance Officer of Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice co-founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field.

Follow Dr. Rice on Twitter @KevinRiceMD

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