ACR TI-RADS Yields Higher Specificity and Accuracy Than EU-TI-RADS in Thyroid Nodule Assessment

In 809 thyroid nodules, ACR TI-RADS showed higher specificity (73.77% vs 35.74%) and accuracy (76.14% vs 46.35%) than EU-TI-RADS. EU-TI-RADS was slightly more sensitive (90.45% vs 85.99%). ACR's higher specificity suggests it can reduce unnecessary FNA biopsies.

• ACR TI-RADS correctly excluded 481 of 652 benign nodules (specificity 73.77%) versus only 233 for EU-TI-RADS (35.74%), with significantly higher overall accuracy (76.14% vs 46.35%).
• Hypoechogenicity, solid or almost entirely solid composition, and taller-than-wide shape were independent predictors of malignancy; irregular margins and microcalcifications were strongly associated but showed quasi-complete separation.

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