🦋 Thyroid Nodule ACR TI-RADS & FNA Decision
Score thyroid-nodule ultrasound features per ACR TI-RADS (TR1–5) and get an FNA or follow-up recommendation from the level and nodule size. Instant, browser-side.
Punctate echogenic foci (microcalcifications) add 3 points and strongly raise suspicion.
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When to use
Standardised malignancy-risk assessment of a thyroid nodule on ultrasound, with FNA/follow-up size thresholds.
How it works
Sum five features — composition, echogenicity, shape, margin, echogenic foci — into TR1 (0), TR2 (1–2), TR3 (3), TR4 (4–6), TR5 (≥ 7). FNA/follow-up thresholds: TR3 ≥ 2.5/1.5 cm, TR4 ≥ 1.5/1.0 cm, TR5 ≥ 1.0/0.5 cm.
Key points
- Punctate echogenic foci (microcalcifications) add 3 points and strongly raise suspicion.
- ACR generally does not biopsy nodules < 1 cm even when TR5 (active surveillance is an option for 5–9 mm).
- With multiple nodules, assess the 1–2 with the highest TR rather than the largest.
- TR1–2 need no FNA; FNA vs follow-up depends on the size thresholds.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Composition | Cystic / spongiform (0) |
|---|---|
| Echogenicity | Anechoic (0) |
| Shape (aspect ratio) | Wider-than-tall, ratio < 1 (0) |
| Margin | Smooth / ill-defined (0) |
| Echogenic foci: macrocalcifications (+1) | Yes |
| Echogenic foci: peripheral/rim calcifications (+2) | Yes |
| Echogenic foci: punctate echogenic foci / microcalcifications (+3) | Yes |
| Maximum nodule diameter | 1.2 cm |
→DispositionUltrasound follow-up recommended
- TI-RADS total：6 points
- Level：TR4 (Moderately suspicious (5–20%))
- Max diameter：1.2 cm
| Composition | Solid / almost completely solid (2) |
|---|---|
| Echogenicity | Very hypoechoic (3) |
| Shape (aspect ratio) | Taller-than-wide, ratio ≥ 1 (3) |
| Margin | Extra-thyroidal extension (3) |
| Echogenic foci: macrocalcifications (+1) | No |
| Echogenic foci: peripheral/rim calcifications (+2) | No |
| Echogenic foci: punctate echogenic foci / microcalcifications (+3) | No |
| Maximum nodule diameter | 1.2 cm |
→DispositionFNA recommended
- TI-RADS total：11 points
- Level：TR5 (Highly suspicious (≥ 20%))
- Max diameter：1.2 cm
Frequently asked questions
- What is Thyroid Nodule ACR TI-RADS & FNA Decision?
- Score thyroid-nodule ultrasound features per ACR TI-RADS (TR1–5) and get an FNA or follow-up recommendation from the level and nodule size. Instant, browser-side.
- How is Thyroid Nodule ACR TI-RADS & FNA Decision calculated? What is the core formula?
- Sum five features — composition, echogenicity, shape, margin, echogenic foci — into TR1 (0), TR2 (1–2), TR3 (3), TR4 (4–6), TR5 (≥ 7). FNA/follow-up thresholds: TR3 ≥ 2.5/1.5 cm, TR4 ≥ 1.5/1.0 cm, TR5 ≥ 1.0/0.5 cm.
- When is Thyroid Nodule ACR TI-RADS & FNA Decision used?
- Standardised malignancy-risk assessment of a thyroid nodule on ultrasound, with FNA/follow-up size thresholds.
- What are the key clinical points for Thyroid Nodule ACR TI-RADS & FNA Decision?
- Punctate echogenic foci (microcalcifications) add 3 points and strongly raise suspicion. ACR generally does not biopsy nodules < 1 cm even when TR5 (active surveillance is an option for 5–9 mm). With multiple nodules, assess the 1–2 with the highest TR rather than the largest. TR1–2 need no FNA; FNA vs follow-up depends on the size thresholds.
- What are the limits and cautions when using Thyroid Nodule ACR TI-RADS & FNA Decision?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Thyroid Nodule ACR TI-RADS & FNA Decision calculated in practice? Can you show a worked example?
- Inputs: Composition Cystic / spongiform (0), Echogenicity Anechoic (0), Shape (aspect ratio) Wider-than-tall, ratio < 1 (0), Margin Smooth / ill-defined (0), Echogenic foci: macrocalcifications (+1) Yes, Echogenic foci: peripheral/rim calcifications (+2) Yes, Echogenic foci: punctate echogenic foci / microcalcifications (+3) Yes, Maximum nodule diameter 1.2 cm → Result: Disposition Ultrasound follow-up recommended（TI-RADS total: 6 points, Level: TR4 (Moderately suspicious (5–20%)), Max diameter: 1.2 cm） Inputs: Composition Solid / almost completely solid (2), Echogenicity Very hypoechoic (3), Shape (aspect ratio) Taller-than-wide, ratio ≥ 1 (3), Margin Extra-thyroidal extension (3), Echogenic foci: macrocalcifications (+1) No, Echogenic foci: peripheral/rim calcifications (+2) No, Echogenic foci: punctate echogenic foci / microcalcifications (+3) No, Maximum nodule diameter 1.2 cm → Result: Disposition FNA recommended（TI-RADS total: 11 points, Level: TR5 (Highly suspicious (≥ 20%)), Max diameter: 1.2 cm）