# TI-RADS — ACR Thyroid Imaging Reporting and Data System

> Point based ultrasound risk stratification of thyroid nodules across five feature categories, mapping a total score to a TR level and to biopsy or follow up by size.

**Situação:** vigente · **Órgão:** Tireoide · **Órgão emissor:** American College of Radiology · **Versão:** 2017 · **Ano:** 2017

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: léxico
- Tipo de lógica: score
- Modalidade: US
- Fonte primária: Tessler FN, Middleton WD, Grant EG, et al.. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee (2017) — https://doi.org/10.1016/j.jacr.2017.01.046
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
The score selects TR1-TR5; maximum nodule size then selects no action, scheduled ultrasound follow-up, or FNA. Previously biopsied and PET-avid nodules require the documented exceptions.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| TR1 | Benign | Total of 0 points across the five ACR TI-RADS feature categories (composition, echogenicity, shape, margin, echogenic foci). | No FNA and no follow-up recommended at any size. | Benign category; partial NMD analysis cited in the paper reports cancer risk of no more than 2% for TR1 and TR2 nodules combined. | ACR TI-RADS points table / risk-stratification chart (0 Points = TR1, Benign; "No FNA" row); discussion section ("cancer risk levels of no more than 2% for TR1 and TR2 nodules") | ✓ |
| TR2 | Not suspicious | Total of 2 points after adding the selected composition, echogenicity, shape, margin, and all applicable echogenic-foci values. | No FNA and no follow-up recommended at any size. | Not Suspicious category; partial NMD analysis cited in the paper reports cancer risk of no more than 2% for TR1 and TR2 nodules combined. | ACR TI-RADS points table / chart (2 Points = TR2, Not Suspicious; "No FNA" row); discussion section ("no more than 2% for TR1 and TR2 nodules") | ✓ |
| TR3 | Mildly suspicious | Total of 3 points after adding the selected composition, echogenicity, shape, margin, and all applicable echogenic-foci values. | FNA when maximum diameter is 2.5 cm or larger. For nodules 1.5-2.4 cm, follow-up ultrasound at 1, 3, and 5 years. No FNA or routine follow-up below 1.5 cm. | Mildly Suspicious category; partial NMD analysis cited in the paper reports cancer risk of approximately 5% for TR3 nodules. | ACR TI-RADS Atlas/assessment chart (3 points = TR3; FNA >=2.5 cm; follow >=1.5 cm); ACR Diagnostic Ultrasound Reporting Template, recommendation schedule (follow-up at years 1, 3, and 5); white-paper discussion (approximately 5% risk) | ✓ |
| TR4 | Moderately suspicious | Total of 4-6 points after adding the selected composition, echogenicity, shape, margin, and all applicable echogenic-foci values. | FNA when maximum diameter is 1.5 cm or larger. For nodules 1.0-1.4 cm, follow-up ultrasound at 1, 2, 3, and 5 years. No FNA or routine follow-up below 1.0 cm. | Moderately Suspicious category; partial NMD analysis cited in the paper reports cancer risk of approximately 5% to 20% for TR4 nodules. | ACR TI-RADS Atlas/assessment chart (4-6 points = TR4; FNA >=1.5 cm; follow >=1.0 cm); ACR Diagnostic Ultrasound Reporting Template, recommendation schedule (follow-up at years 1, 2, 3, and 5); white-paper discussion (approximately 5%-20% risk) | ✓ |
| TR5 | Highly suspicious | Total of 7 points or more after adding the selected composition, echogenicity, shape, margin, and all applicable echogenic-foci values. | FNA when maximum diameter is 1.0 cm or larger. For nodules 0.5-0.9 cm, follow-up ultrasound every year for 5 years. No FNA or routine follow-up below 0.5 cm. | Highly Suspicious category; partial NMD analysis cited in the paper reports cancer risk of at least 20% for TR5 nodules. | ACR TI-RADS Atlas/assessment chart (>=7 points = TR5; FNA >=1.0 cm; follow >=0.5 cm); ACR Diagnostic Ultrasound Reporting Template, recommendation schedule (annual follow-up for 5 years); white-paper discussion (at least 20% risk) | ✓ |

### Citações por categoria
- **TR1**: Tessler FN, Middleton WD, Grant EG, et al.. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee (2017) — https://doi.org/10.1016/j.jacr.2017.01.046 · ACR TI-RADS points table / risk-stratification chart (0 Points = TR1, Benign; "No FNA" row); discussion section ("cancer risk levels of no more than 2% for TR1 and TR2 nodules")
- **TR2**: Tessler FN, Middleton WD, Grant EG, et al.. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee (2017) — https://doi.org/10.1016/j.jacr.2017.01.046 · ACR TI-RADS points table / chart (2 Points = TR2, Not Suspicious; "No FNA" row); discussion section ("no more than 2% for TR1 and TR2 nodules")
- **TR3**: Tessler FN, Middleton WD, Grant EG, et al.. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee (2017) — https://doi.org/10.1016/j.jacr.2017.01.046 · ACR TI-RADS Atlas/assessment chart (3 points = TR3; FNA >=2.5 cm; follow >=1.5 cm); ACR Diagnostic Ultrasound Reporting Template, recommendation schedule (follow-up at years 1, 3, and 5); white-paper discussion (approximately 5% risk)
- **TR4**: Tessler FN, Middleton WD, Grant EG, et al.. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee (2017) — https://doi.org/10.1016/j.jacr.2017.01.046 · ACR TI-RADS Atlas/assessment chart (4-6 points = TR4; FNA >=1.5 cm; follow >=1.0 cm); ACR Diagnostic Ultrasound Reporting Template, recommendation schedule (follow-up at years 1, 2, 3, and 5); white-paper discussion (approximately 5%-20% risk)
- **TR5**: Tessler FN, Middleton WD, Grant EG, et al.. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee (2017) — https://doi.org/10.1016/j.jacr.2017.01.046 · ACR TI-RADS Atlas/assessment chart (>=7 points = TR5; FNA >=1.0 cm; follow >=0.5 cm); ACR Diagnostic Ultrasound Reporting Template, recommendation schedule (annual follow-up for 5 years); white-paper discussion (at least 20% risk)

## Referências cruzadas
- _fronteira compartilhada_ → [BI-RADS — Breast Imaging Reporting and Data System, 5th edition](https://radcommons.laudos.ai/systems/bi-rads-2013.md) — Shares the ACR Reporting and Data System framework that BI-RADS established.
- _fronteira compartilhada_ → [EU-TIRADS — European Thyroid Imaging Reporting and Data System](https://radcommons.laudos.ai/systems/eu-tirads.md) — European alternative to ACR TI-RADS for thyroid nodule risk stratification, with different thresholds.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-08-11 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-09 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-07 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-06 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-05 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-04 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-31 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-24 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-23 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-21 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-20 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-19 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-18 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-17 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-16 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-15 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-10 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-08 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-07 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-05 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-06-30 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-06-29 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-06-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-06-24 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2017-05-01 | published | ACR TI-RADS white paper published in JACR. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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