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ACR TI-RADS Risk Score Escalation Observed in Benign Thyroid Nodules following Radiofrequency Ablation
Tess J Battiola1, Richard H Wiggins2, Devaprabu Abraham3
1From the Division of Endocrinology (T.J.B., D.A.), Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah tess.j.lange@gmail.com.
AJNR. American Journal of Neuroradiology
|September 30, 2025
Summary
Radiofrequency ablation (RFA) for thyroid nodules can alter ultrasound appearance, leading to higher ACR TI-RADS scores. These post-treatment changes are expected and should not prompt unnecessary clinical action or patient anxiety.
Area of Science:
- Endocrinology
- Radiology
- Oncology
Background:
- Radiofrequency ablation (RFA) is a key non-surgical treatment for symptomatic benign thyroid nodules and toxic adenomas.
- Post-RFA ultrasound changes are common but can be misinterpreted by risk stratification systems like ACR TI-RADS.
- This can lead to unnecessary interventions and patient anxiety.
Purpose of the Study:
- To quantify changes in ACR TI-RADS scores for thyroid nodules before and after RFA.
- To evaluate the impact of post-RFA ultrasound characteristics on risk stratification.
- To emphasize that these expected changes should not guide clinical decisions.
Main Methods:
- Retrospective analysis of patients undergoing RFA for thyroid nodules.
- Pre-treatment assessment using ACR TI-RADS and fine-needle aspiration (FNA) biopsy.
- Post-RFA ultrasound monitoring at 3-month intervals with reassessment of TI-RADS scores.
Main Results:
- 28 nodules from 25 patients were analyzed with a median follow-up of 419 days.
- 92.9% of nodules were benign (Bethesda II) on FNA.
- Mean TI-RADS score increased from 3.04 to 4.25 (p<0.001) post-RFA, driven by hypo-echogenicity and calcifications, despite significant volume reduction (mean 66.7%).
Conclusions:
- Post-RFA structural changes in thyroid nodules frequently lead to misleading upstaging on the ACR TI-RADS system.
- These expected changes necessitate cautious interpretation to prevent overdiagnosis and patient distress.
- RFA remains an effective treatment, but its post-procedural imaging findings require careful clinical correlation.
