This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
To assess the underestimation of radiation dose to the thyroid of children undergoing contrast en... more To assess the underestimation of radiation dose to the thyroid of children undergoing contrast enhanced CT if contrast medium uptake is not taken into account. Methods: 161 pediatric head, head & neck and chest CT examinations were retrospectively studied to identify those involving pre-and post-contrast imaging and thyroid inclusion in imaged volume. CT density of thyroid tissue in HU was measured in non-enhanced (NECT) and corresponding contrast-enhanced CT (CECT) images. Resulting CT number increase (ΔHU) was recorded for each patient and corresponded to a % w/w iodine concentration. The relation of %w/w iodine concentration to %dose increase induced by iodinated contrast uptake was derived by Monte Carlo simulation experiments. Results: The thyroid gland was visible in 11 chest and 3 neck CT examinations involving both pre-and postcontrast imaging. The %w/w concentration of iodine in the thyroid tissue at the time of CECT acquisition was found to be 0.13%-0.58% w/w (mean = 0.26%). The %increase of dose to thyroid tissue was found to be linearly correlated to%w/w iodine uptake. The increase in radiation dose to thyroid due to contrast uptake ranged from 12% to 44%, with a mean value of 23%. Conclusions: The radiation dose to the pediatric thyroid from CECT exposure may be underestimated by up to 44% if contrast medium uptake is not taken into account. Meticulous demarcation of imaged volume in pediatric chest CT examinations is imperative to avoid unnecessary direct exposure of thyroid, especially in CT examinations following intravenous administration of contrast medium.
Poster: "ECR 2018 / C-0678 / Transthoracic lung ultrasonography in idiopathic pulmonary fibr... more Poster: "ECR 2018 / C-0678 / Transthoracic lung ultrasonography in idiopathic pulmonary fibrosis: correlation with high-resolution computed tomographic findings and evaluation of new imaging protocols" by: "E. Vassalou1, M. Raissaki1, E. Magkanas2, K. Antoniou1, A. H. Karantanas1; 1Iraklion/GR, 2Nottingham/UK"
Ingested foreign bodies occur in children younger than 3 years and pass uneventfully through the ... more Ingested foreign bodies occur in children younger than 3 years and pass uneventfully through the gastrointestinal tract. However, multiple magnet ingestion are associated with serious complications. A 9-year old male with abdominal pain and vomiting 3 days prior to admission, underwent abdominal radiographs showing radiopaque foreign bodies. Ultrasonography (US) independently discovered one magnet floating in the jejunum. Preoperative Computed Tomography (CT) confirmed the presence of two neighbouring magnets causing obstruction and beaking of an adjacent jejunal loop. Laparotomy led to uneventful recovery of transmesenteric fistula formation following pressure necrosis in two jejunal loops. We present the first case of multiple magnet ingestion managed in our institution, where the prevalence of magnet ingestions is low due to unpopularity of magnet toys. Conclusion: Awareness of the potentially devastating effects of multiple magnets passing the pylorus and the contribution of different imaging modalities for the diagnosis are emphasized and discussed.
Glucose transporter type 1 (Glut1) deficiency syndrome is a treatable neurometabolic disorder cha... more Glucose transporter type 1 (Glut1) deficiency syndrome is a treatable neurometabolic disorder characterized by seizures, developmental delay, and hypoglycorrhachia. Due to the rareness and non‐specific clinical manifestations, it is usually mis‐ or underdiagnosed.
Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals w... more Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals with predisposing conditions. The aim of this study was to evaluate the community-acquired enterococcal UTIs in otherwise well children. We reviewed all the 257 first UTI episodes in children hospitalized in a General Hospital during a 5-year period. Enterococcus faecalis was isolated in 13 episodes, accounting for 5.1% of the total UTIs. All strains were susceptible to ampicillin, vancomycin and nitrofurantoin. Imaging studies revealed major urinary tract abnormalities in 9 and parenchymal defects in 8 children. During a follow-up period from 2 to 6 years, 4 children suffered breakthrough infections despite antibiotic prophylaxis, 3 developed renal scarring and 4 underwent corrective surgical procedures. Children with enterococcal UTIs presented with significantly higher rates of anatomical abnormalities and worse prognosis in terms of renal scarring, recurrences and corrective surgery compared with the total cohort of children with Gramnegative UTIs. However children with enterococcal UTIs did not present with a worse prognosis when compared with a group of children with Gram-negative UTIs matched for age and degree of reflux. Enterococcal infection is not an independent risk factor for poor outcome, nevertheless positive urine culture including enterococci is highly indicative for underlying urinary tract abnormalities, recurrences, renal scarring, and need for surgical intervention.
Originally, the article was published with inverted author names. The author names are now correc... more Originally, the article was published with inverted author names. The author names are now correctly cited. The original article has been corrected.
Poster: "ECR 2016 / C-1435 / Multifocal bone lesions in children: MRI findings." by: &q... more Poster: "ECR 2016 / C-1435 / Multifocal bone lesions in children: MRI findings." by: "M. Raissaki1, S. Demetriou1, C. Skiadas1, K. SPANAKIS2, M. Stratigaki1, N. Katzilakis1, E. Stiakaki1, A. H. Karantanas1; 1Heraklion/GR, 2Iraklion/GR"
Purpose. To evaluate foot perfusion in patients with critical limb ischemia (CLI) using dynamic c... more Purpose. To evaluate foot perfusion in patients with critical limb ischemia (CLI) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and estimate perfusion parameters changes after percutaneous transluminal angioplasty (PTA). Methods. Eight patients (5 male, median age 68 years, range 58-79 years) with CLI [Rutherford 4 (n = 2), Rutherford 5 (n = 5), Rutherford 6 (n = 1)] were examined. All patients underwent DCE-MRI of the lower calf and foot, 1 day before (pre-PTA) and 1 month after (post-PTA) revascularization. Perfusion parameters such as blood flow (BF), K trans , K ep were analyzed and applied for statistical comparisons. Wilcoxon signed rank tests were used to compare pre and post-PTA perfusion parameters. Results. Revascularization was technically successful in all cases with significant clinical improvement. In addition, the ankle brachial index (ABI) increased from 0.35 ± 0.2 to 0.76 ± 0.25, p < 0.05. During follow-up (mean duration 18 months), one patient died due to acute myocardial infarction and there were two minor toe amputations. After PTA, mean BF increased from 6.18 ± 3.221 ± 9.788 ± 3.346, K trans increased from 0.063 ± 0.024 to 0.106 ± 0.045 and K ep increased from 0.102 ± 0.026 to 0.145 ± 0.026, p < 0.05. Conclusions. DCE-MRI may be a useful means for the diagnosis of foot hypo-perfusion. It seems also to be a promising tool for evaluation of PTA outcome, as significant restitution of perfusion parameters was observed after successful revascularization.
This second roundtable discussion was convened at the 56th European Society of Paediatric Radiolo... more This second roundtable discussion was convened at the 56th European Society of Paediatric Radiology (ESPR) 2022 Annual Meeting in Marseille, France, to discuss controversial aspects of imaging in child abuse. The following topics were discussed: • Fracture dating-the published literature is broadly similar with respect to the identification of the radiographic stages of bony healing. The non-expert/general radiologist is encouraged to use broad descriptors of fracture healing (acute, healing or old) within their reports, rather than attempting to date fractures. The more experienced/expert radiologist, who may provide a timeframe/range to assist the courts, should be aware that any published timeframes are not absolute and that recent research indicates that the rate of healing may differ according to the bone affected and the age of the patient. • Whole spine imaging in suspected abusive head traumathis is recommended to enable a complete assessment of the
ImportancePhysical abuse is a common but preventable cause of long-term childhood morbidity and m... more ImportancePhysical abuse is a common but preventable cause of long-term childhood morbidity and mortality. Despite the strong association between abuse in an index child and abuse in contact children, there is no guidance outlining how to screen the latter, significantly more vulnerable group, for abusive injuries. Consequently, the radiological assessment of contact children is often omitted, or variably performed, allowing occult injuries to go undetected and increasing the risk of further abuse.ObjectiveTo report an evidence-based and consensus-derived set of best practices for the radiological screening of contact children in the context of suspected child physical abuse.Evidence ReviewThis consensus statement is supported by a systematic review of the literature and the clinical opinion of an internationally recognized group of 26 experts. The modified Delphi consensus process comprised 3 meetings of the International Consensus Group on Contact Screening in Suspected Child Phys...
Background Pulmonary infection with SARS-CoV-2 virus (severe acute respiratory syndrome coronavir... more Background Pulmonary infection with SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2; COVID-19) has rapidly spread worldwide to become a global pandemic. Objective To collect paediatric COVID-19 cases worldwide and to summarize both clinical and imaging findings in children who tested positive on polymerase chain reaction testing for SARS-CoV-2. Materials and methods Data were collected by completion of a standardised case report form submitted to the office of the European Society of Paediatric Radiology from March 12 to April 8, 2020. Chest imaging findings in children younger than 18 years old who tested positive on polymerase chain reaction testing for SARS-CoV-2 were included. Representative imaging studies were evaluated by multiple senior paediatric radiologists from this group with expertise in paediatric chest imaging. Results Ninety-one children were included (49 males; median age: 6.1 years, interquartile range: 1.0 to 13.0 years, range: 9 days-17 years). Most had mild symptoms, mostly fever and cough, and one-third had coexisting medical conditions. Eleven percent of children presented with severe symptoms and required intensive unit care. Chest radiographs were available in 89% of patients and 10% of them were normal. Abnormal chest radiographs showed mainly perihilar bronchial wall thickening (58%) and/or airspace consolidation (35%). Computed tomography (CT) scans were available in 26% of cases, with the most common abnormality being ground glass opacities (88%) and/or airspace consolidation (58%). Tree in bud opacities were seen in 6 of 24 CTs (25%). Lung ultrasound and chest magnetic resonance imaging were rarely utilized. Conclusion It seems unnecessary to perform chest imaging in children to diagnose COVID-19. Chest radiography can be used in symptomatic children to assess airway infection or pneumonia. CT should be reserved for when there is clinical concern to assess for possible complications, especially in children with coexisting medical conditions.
The original version on this paper contained an error. The COI statement is incorrectly presented... more The original version on this paper contained an error. The COI statement is incorrectly presented. The correct statement is presented below: Conflicts of interest Drs. Narang, Palusci and Hedlund have been paid as expert consultants in cases of suspected abusive head trauma. Drs. Choudhary, Christian, Servaes, Nelson, Palasis, Rossi and Offiah provide medical-legal expert work in child abuse cases. Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
In infants without a history of trauma, subdural haemorrhages should raise the concern for an abu... more In infants without a history of trauma, subdural haemorrhages should raise the concern for an abusive head injury, particularly when they are associated with bridging vein clotting/rupture or with septations. However, non-haemorrhagic, fluid-appearing subdural collections (also called hygromas) may also be the result of abuse. Subdural collections have also been uncommonly observed in patients with benign enlargement of the subarachnoid spaces (BESS) and a few large-scale studies accurately investigate the incidence and the significance. Currently, there is a wide variation of practices in children with BESS and subdural collections. Due to the social risks associated with abuse evaluation and the perceived risk of radiation exposure, there might be a reluctance to fully evaluate these children in some centres. The diagnosis of physical abuse cannot be substantiated nor safely excluded in infants with BESS and subdural collection(s), without investigation for concomitant traumatic f...
Poster: "ESTI 2019 / P-0032 / Chest HRCT findings in former cigarette smokers" by: &quo... more Poster: "ESTI 2019 / P-0032 / Chest HRCT findings in former cigarette smokers" by: "E. Detorakis1, M. Raissaki2, K. Antoniou2, I. Papadopoulou2, R. Illing3; 1Iraklion/GR, 2Heraklion/GR, 3Budapest/HU"
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
To assess the underestimation of radiation dose to the thyroid of children undergoing contrast en... more To assess the underestimation of radiation dose to the thyroid of children undergoing contrast enhanced CT if contrast medium uptake is not taken into account. Methods: 161 pediatric head, head & neck and chest CT examinations were retrospectively studied to identify those involving pre-and post-contrast imaging and thyroid inclusion in imaged volume. CT density of thyroid tissue in HU was measured in non-enhanced (NECT) and corresponding contrast-enhanced CT (CECT) images. Resulting CT number increase (ΔHU) was recorded for each patient and corresponded to a % w/w iodine concentration. The relation of %w/w iodine concentration to %dose increase induced by iodinated contrast uptake was derived by Monte Carlo simulation experiments. Results: The thyroid gland was visible in 11 chest and 3 neck CT examinations involving both pre-and postcontrast imaging. The %w/w concentration of iodine in the thyroid tissue at the time of CECT acquisition was found to be 0.13%-0.58% w/w (mean = 0.26%). The %increase of dose to thyroid tissue was found to be linearly correlated to%w/w iodine uptake. The increase in radiation dose to thyroid due to contrast uptake ranged from 12% to 44%, with a mean value of 23%. Conclusions: The radiation dose to the pediatric thyroid from CECT exposure may be underestimated by up to 44% if contrast medium uptake is not taken into account. Meticulous demarcation of imaged volume in pediatric chest CT examinations is imperative to avoid unnecessary direct exposure of thyroid, especially in CT examinations following intravenous administration of contrast medium.
Poster: "ECR 2018 / C-0678 / Transthoracic lung ultrasonography in idiopathic pulmonary fibr... more Poster: "ECR 2018 / C-0678 / Transthoracic lung ultrasonography in idiopathic pulmonary fibrosis: correlation with high-resolution computed tomographic findings and evaluation of new imaging protocols" by: "E. Vassalou1, M. Raissaki1, E. Magkanas2, K. Antoniou1, A. H. Karantanas1; 1Iraklion/GR, 2Nottingham/UK"
Ingested foreign bodies occur in children younger than 3 years and pass uneventfully through the ... more Ingested foreign bodies occur in children younger than 3 years and pass uneventfully through the gastrointestinal tract. However, multiple magnet ingestion are associated with serious complications. A 9-year old male with abdominal pain and vomiting 3 days prior to admission, underwent abdominal radiographs showing radiopaque foreign bodies. Ultrasonography (US) independently discovered one magnet floating in the jejunum. Preoperative Computed Tomography (CT) confirmed the presence of two neighbouring magnets causing obstruction and beaking of an adjacent jejunal loop. Laparotomy led to uneventful recovery of transmesenteric fistula formation following pressure necrosis in two jejunal loops. We present the first case of multiple magnet ingestion managed in our institution, where the prevalence of magnet ingestions is low due to unpopularity of magnet toys. Conclusion: Awareness of the potentially devastating effects of multiple magnets passing the pylorus and the contribution of different imaging modalities for the diagnosis are emphasized and discussed.
Glucose transporter type 1 (Glut1) deficiency syndrome is a treatable neurometabolic disorder cha... more Glucose transporter type 1 (Glut1) deficiency syndrome is a treatable neurometabolic disorder characterized by seizures, developmental delay, and hypoglycorrhachia. Due to the rareness and non‐specific clinical manifestations, it is usually mis‐ or underdiagnosed.
Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals w... more Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals with predisposing conditions. The aim of this study was to evaluate the community-acquired enterococcal UTIs in otherwise well children. We reviewed all the 257 first UTI episodes in children hospitalized in a General Hospital during a 5-year period. Enterococcus faecalis was isolated in 13 episodes, accounting for 5.1% of the total UTIs. All strains were susceptible to ampicillin, vancomycin and nitrofurantoin. Imaging studies revealed major urinary tract abnormalities in 9 and parenchymal defects in 8 children. During a follow-up period from 2 to 6 years, 4 children suffered breakthrough infections despite antibiotic prophylaxis, 3 developed renal scarring and 4 underwent corrective surgical procedures. Children with enterococcal UTIs presented with significantly higher rates of anatomical abnormalities and worse prognosis in terms of renal scarring, recurrences and corrective surgery compared with the total cohort of children with Gramnegative UTIs. However children with enterococcal UTIs did not present with a worse prognosis when compared with a group of children with Gram-negative UTIs matched for age and degree of reflux. Enterococcal infection is not an independent risk factor for poor outcome, nevertheless positive urine culture including enterococci is highly indicative for underlying urinary tract abnormalities, recurrences, renal scarring, and need for surgical intervention.
Originally, the article was published with inverted author names. The author names are now correc... more Originally, the article was published with inverted author names. The author names are now correctly cited. The original article has been corrected.
Poster: "ECR 2016 / C-1435 / Multifocal bone lesions in children: MRI findings." by: &q... more Poster: "ECR 2016 / C-1435 / Multifocal bone lesions in children: MRI findings." by: "M. Raissaki1, S. Demetriou1, C. Skiadas1, K. SPANAKIS2, M. Stratigaki1, N. Katzilakis1, E. Stiakaki1, A. H. Karantanas1; 1Heraklion/GR, 2Iraklion/GR"
Purpose. To evaluate foot perfusion in patients with critical limb ischemia (CLI) using dynamic c... more Purpose. To evaluate foot perfusion in patients with critical limb ischemia (CLI) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and estimate perfusion parameters changes after percutaneous transluminal angioplasty (PTA). Methods. Eight patients (5 male, median age 68 years, range 58-79 years) with CLI [Rutherford 4 (n = 2), Rutherford 5 (n = 5), Rutherford 6 (n = 1)] were examined. All patients underwent DCE-MRI of the lower calf and foot, 1 day before (pre-PTA) and 1 month after (post-PTA) revascularization. Perfusion parameters such as blood flow (BF), K trans , K ep were analyzed and applied for statistical comparisons. Wilcoxon signed rank tests were used to compare pre and post-PTA perfusion parameters. Results. Revascularization was technically successful in all cases with significant clinical improvement. In addition, the ankle brachial index (ABI) increased from 0.35 ± 0.2 to 0.76 ± 0.25, p < 0.05. During follow-up (mean duration 18 months), one patient died due to acute myocardial infarction and there were two minor toe amputations. After PTA, mean BF increased from 6.18 ± 3.221 ± 9.788 ± 3.346, K trans increased from 0.063 ± 0.024 to 0.106 ± 0.045 and K ep increased from 0.102 ± 0.026 to 0.145 ± 0.026, p < 0.05. Conclusions. DCE-MRI may be a useful means for the diagnosis of foot hypo-perfusion. It seems also to be a promising tool for evaluation of PTA outcome, as significant restitution of perfusion parameters was observed after successful revascularization.
This second roundtable discussion was convened at the 56th European Society of Paediatric Radiolo... more This second roundtable discussion was convened at the 56th European Society of Paediatric Radiology (ESPR) 2022 Annual Meeting in Marseille, France, to discuss controversial aspects of imaging in child abuse. The following topics were discussed: • Fracture dating-the published literature is broadly similar with respect to the identification of the radiographic stages of bony healing. The non-expert/general radiologist is encouraged to use broad descriptors of fracture healing (acute, healing or old) within their reports, rather than attempting to date fractures. The more experienced/expert radiologist, who may provide a timeframe/range to assist the courts, should be aware that any published timeframes are not absolute and that recent research indicates that the rate of healing may differ according to the bone affected and the age of the patient. • Whole spine imaging in suspected abusive head traumathis is recommended to enable a complete assessment of the
ImportancePhysical abuse is a common but preventable cause of long-term childhood morbidity and m... more ImportancePhysical abuse is a common but preventable cause of long-term childhood morbidity and mortality. Despite the strong association between abuse in an index child and abuse in contact children, there is no guidance outlining how to screen the latter, significantly more vulnerable group, for abusive injuries. Consequently, the radiological assessment of contact children is often omitted, or variably performed, allowing occult injuries to go undetected and increasing the risk of further abuse.ObjectiveTo report an evidence-based and consensus-derived set of best practices for the radiological screening of contact children in the context of suspected child physical abuse.Evidence ReviewThis consensus statement is supported by a systematic review of the literature and the clinical opinion of an internationally recognized group of 26 experts. The modified Delphi consensus process comprised 3 meetings of the International Consensus Group on Contact Screening in Suspected Child Phys...
Background Pulmonary infection with SARS-CoV-2 virus (severe acute respiratory syndrome coronavir... more Background Pulmonary infection with SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2; COVID-19) has rapidly spread worldwide to become a global pandemic. Objective To collect paediatric COVID-19 cases worldwide and to summarize both clinical and imaging findings in children who tested positive on polymerase chain reaction testing for SARS-CoV-2. Materials and methods Data were collected by completion of a standardised case report form submitted to the office of the European Society of Paediatric Radiology from March 12 to April 8, 2020. Chest imaging findings in children younger than 18 years old who tested positive on polymerase chain reaction testing for SARS-CoV-2 were included. Representative imaging studies were evaluated by multiple senior paediatric radiologists from this group with expertise in paediatric chest imaging. Results Ninety-one children were included (49 males; median age: 6.1 years, interquartile range: 1.0 to 13.0 years, range: 9 days-17 years). Most had mild symptoms, mostly fever and cough, and one-third had coexisting medical conditions. Eleven percent of children presented with severe symptoms and required intensive unit care. Chest radiographs were available in 89% of patients and 10% of them were normal. Abnormal chest radiographs showed mainly perihilar bronchial wall thickening (58%) and/or airspace consolidation (35%). Computed tomography (CT) scans were available in 26% of cases, with the most common abnormality being ground glass opacities (88%) and/or airspace consolidation (58%). Tree in bud opacities were seen in 6 of 24 CTs (25%). Lung ultrasound and chest magnetic resonance imaging were rarely utilized. Conclusion It seems unnecessary to perform chest imaging in children to diagnose COVID-19. Chest radiography can be used in symptomatic children to assess airway infection or pneumonia. CT should be reserved for when there is clinical concern to assess for possible complications, especially in children with coexisting medical conditions.
The original version on this paper contained an error. The COI statement is incorrectly presented... more The original version on this paper contained an error. The COI statement is incorrectly presented. The correct statement is presented below: Conflicts of interest Drs. Narang, Palusci and Hedlund have been paid as expert consultants in cases of suspected abusive head trauma. Drs. Choudhary, Christian, Servaes, Nelson, Palasis, Rossi and Offiah provide medical-legal expert work in child abuse cases. Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
In infants without a history of trauma, subdural haemorrhages should raise the concern for an abu... more In infants without a history of trauma, subdural haemorrhages should raise the concern for an abusive head injury, particularly when they are associated with bridging vein clotting/rupture or with septations. However, non-haemorrhagic, fluid-appearing subdural collections (also called hygromas) may also be the result of abuse. Subdural collections have also been uncommonly observed in patients with benign enlargement of the subarachnoid spaces (BESS) and a few large-scale studies accurately investigate the incidence and the significance. Currently, there is a wide variation of practices in children with BESS and subdural collections. Due to the social risks associated with abuse evaluation and the perceived risk of radiation exposure, there might be a reluctance to fully evaluate these children in some centres. The diagnosis of physical abuse cannot be substantiated nor safely excluded in infants with BESS and subdural collection(s), without investigation for concomitant traumatic f...
Poster: "ESTI 2019 / P-0032 / Chest HRCT findings in former cigarette smokers" by: &quo... more Poster: "ESTI 2019 / P-0032 / Chest HRCT findings in former cigarette smokers" by: "E. Detorakis1, M. Raissaki2, K. Antoniou2, I. Papadopoulou2, R. Illing3; 1Iraklion/GR, 2Heraklion/GR, 3Budapest/HU"
Uploads
Papers by Maria Raissaki