ARRS 2022 Abstracts

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E1934. A Lump in the Throat: Review of TI-RADS Classification of Thyroid Nodules
Authors
  1. Cameron Fateri; Department of Radiological Sciences, University of California, Irvine
  2. Nathan Feil; Department of Radiological Sciences, University of California, Irvine
  3. Thanh-Lan Bui; Department of Radiological Sciences, University of California, Irvine
  4. Scott Cramer; Department of Radiological Sciences, University of California, Irvine
  5. Michael Nguyentat; Department of Radiology, University of Colorado
  6. Roozbeh Houshyar; Department of Radiological Sciences, University of California, Irvine
  7. Mohammad Helmy; Department of Radiological Sciences, University of California, Irvine
Background
Thyroid cancer screening has tripled from 1975 to 2009 while mortality from thyroid cancer has not significantly changed in this time period, suggesting that thyroid cancer might be over diagnosed. Typically, thyroid nodules are first assessed with ultrasound and then fine needle aspiration if indicated. The American College of Radiology’s Thyroid Imaging Reporting and Data System (TI-RADS) is designed to improve diagnostic accuracy and decrease unnecessary biopsies of suspicious thyroid nodules. TI-RADS assigns scores in five categories: composition, echogenicity, shape, margins, and echogenic foci, and then uses these to assign an overall TI-RADS score, which correlates to the likelihood of malignancy with higher scores indicating a higher likelihood.

Educational Goals / Teaching Points
This educational exhibit will review the TI-RADS guidelines and highlight the features used to delineate low- and high-risk thyroid nodules. By the end of this presentation, viewers will be able to determine when to intervene and perform a biopsy, when to follow up on nodule growth, and when to recommend no further evaluation.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Ultrasound is the first imaging modality for the assessment of thyroid nodules. TI-RADS scoring is applied to ultrasound findings. The five categories that make up the TI-RADS score are composition (cystic or completely cystic, spongiform, mixed cystic and solid, solid or almost completely solid); echogenicity (anechoic, hyper or isoechoic, hypoechoic, very hypoechoic); shape as assessed in the transverse plane (wider than tall, taller than wide); margin (smooth, ill-defined, lobulated or irregular, extra-thyroidal extension), and echogenic foci (none, large comet-tail artifact, macrocalcifications, peripheral or rim calcifications, punctate echogenic foci). When multiple thyroid nodules are present, only the four highest scoring nodules are reported and followed up for future evaluation.

Conclusion
Assessment of thyroid nodules using a standardized system of graded features has the potential to give reliable predictions on which nodules require intervention. Therefore, it is essential for radiologists to understand and be able to apply the TI-RADS scoring system when reading thyroid ultrasound to ensure appropriate management.