TI-RADS Calculator

Calculates TI-RADS Score

Description of Features


Echogenic Foci





Cystic or almost completely cystic


  • Cystic: Entirely fluid filled

Mixed cystic and solid

  • Mixed cystic and solid: Assign points for predominant solid component.

Solid or almost completely solid

  • Solid or almost entirely solid: Entirely or nearly entirely soft tissue with only a few tiny cystic spaces


  • Spongiform: Composed predominantly (>50%) of small cystic spaces.


Echogenic Foci

Large comet tail artifacts

  • Comet-tail artifacts: Deeper echoes attenuated with decreased width resulting in a triangular shape. V-shaped, >1 mm, in cystic components.


  • Macrocalcifications: Calcifications with posterior acoustic shadowing

Peripheral rim calcifications

  • Peripheral calcifications: Calcifications at periphery of the nodule. Complete or incomplete along margin.

Punctate echogenic foci

  • Punctate echogenic foci: < 1 mm with no posterior acoustic shadowing. May have small comet-tail artifacts.



  • Anechoic: Applies to cystic or almost completely cystic nodules.

Hyperechoic or isoechoic

  • Hyperechoic: Increased echogenicity relative to the thyroid tissue
  • Isoechoic: Similar echogenicity relative to the thyroid tissue


  • Hypoechoic: Decreased echogenicity relative to the thyroid tissue

Very hypoechoic

  • Very hypoechoic: Decreased echogenicity relative to the adjacent neck musculature
  • Very hypoechoic nodule. Margins are smooth. Note that nodule is less echogenic than adjacent strap muscles (S) and essentially isoechoic to the common carotid artery (C).



Extra-thyroidal extension

  • Extrathyroidal extension: Nodule extends through the thyroid capsule. Obvious invasion = malignancy.


  • Ill-defined: Border difficult to discern from thyroid parenchyma

Lobulated or irregular

  • Irregular margin: Spiculated, jagged or sharp angles even if only in part of the nodule
  • Lobulated: Focal round soft tissue protrusions into adjacent parenchyma that may be single or multiple


  • Smooth: Uninterrupted, well-defined, curvilinear edge typically spherical or elliptical in shape




  • Taller-than-wide: Ratio of AP diameter to the horizontal diameter is > 1 when measured in the transverse plane
  • Should be assessed on a transverse image with measurements parallel to sound beam for height and perpendicular to sound beam for width.
  • This can usually be assessed by visual inspection.