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. 2020 Mar 26;10(4):180. doi: 10.3390/diagnostics10040180

Table 1.

Comparative US Classification of Nodules used in the study: European Thyroid Imaging and Reporting Data System (TI-RADS) versus American College of Radiology (ACR) TI-RADS (2016) versus Horvath TI-RADS (2009) versus French TI-RADS.

Category EU-TIRADS ACR TIRADS * Horvath TIRADS French TIRADS
(Includes Elastography)
1 No nodules. Score = 0 No nodules. No nodules.
2 Cyst/Spongiform. Score = 2 Colloid/spongiform/Mixed isoechoic. Cyst/Isolated macrocalcification/Spongiform
3 Oval, smooth margins,
iso-/hyperechoic,
no suspicious feature.		 Score = 3 Hashimoto pseudo-nodule. Oval, regular margins, iso/hyperechoic
4 Oval, smooth margins,
mild hypoechoic,
no suspicious feature.		 Score = 4–6 4A:

  • Hyper, iso, or hypoechoic nodule + thin capsule

  • Hypoechoic, ill-defined borders, no calcifications

  • Hypervascularized, nodule with thick capsule and calcifications.

 4A:
Oval, regular margins, mild hypoechoic
4B:
Hypoechoic, irregular shape and margins, penetrating vessels ±calcifications 		4B:
High suspicion features (1–2)

  • Taller-than-wide

  • Irregular margins

  • Marked hypoechoic

  • Microcalcifications

  • Stiff on elastography
5 Suspicious features (min 1):
-irregular shape
-irregular margins
-microcalcifications
-marked hypoechoic		 Score ≥ 7

  • Iso/hypoechoic, nonencapsulated multiple peripheral microcalcifications hypervascular

  • Nonencapsulated, isoechoic mixed, hypervascular ± calcifications

 High suspicion features (3–5)
and/or Lymph node metastasis

* For the ACR TI-RADS, a cumulative score from five categories of ultrasound findings is determined (composition, echogenicity, shape, margins and presence of echogenic foci).