ABSTRACT Objective This study explore the efficacy of micro-flow imaging combined with 2017 American College of Radiology（ACR）thyroid report and data system（TI-RADS）stratification in differentiating benign and malignant thyroid nodules.Methods 97 thyroid nodules confirmed by pathology were analyzed，all of which had complete two dimension ultrasound and MFI image data.The nodules were classified by TI-RADS，The pathological results were compared.The sensitivity and specificity of TI-RADS alone and TI-RADS combined with MFI were analyzed，the ROC curve was drawn，and the area under the curve（AUC）was compared.And the rate of unnecessary puncture was compared.Results The area under ROC curve of TI-RADS combined with MFI diagnosis was 0.930，which was larger than TI-RADS alone（0.864），and the difference was statistically significant（P＜0.05）.In the TI-RADS classification，the unnecessary puncture rate was 27.8%（27/97），and decreased to 8.2%（8/97）after combined with MFI application，and the difference was statistically significant（P＜0.05）.Conclusion MFI combined with TI-RADS classification can improve the diagnostic efficiency of benign and malignant thyroid nodules and reduce the rate of unnecessary puncture.