ACR TI-RADS Reference Guide

TI-RADS Scoring System

Composition

Echogenicity

Shape

Margin

Echogenic Foci

TI-RADS Categories

FNA and Follow-Up Recommendations

TI-RADS Category Size Threshold (cm) FNA Recommendation Follow-Up Ultrasound
TR1 Any size No FNA No follow-up
TR2 Any size No FNA Optional follow-up if ≥2.5 cm
TR3 ≥2.5 Consider FNA Follow-up if ≥1.5 cm (1, 3, 5 yrs)
TR4 ≥1.5 FNA Follow-up if 1.0–1.4 cm (1, 2, 5 yrs)
TR5 ≥1.0 FNA Follow-up if 0.5–0.9 cm (1, 3, 5 yrs)