Maria Raissaki

Medical School University of Crete · Radiology Department University Hospital of Heraklion Crete Greece

The most common acute infection and leading cause of death in children worldwide is pneumonia. Clinical and laboratory tests essentially diagnose community-acquired pneumonia (CAP). CAP can be caused by bacteria, viruses, or atypical microorganisms. Imaging is usually reserved for children who do not respond to treatment, need hospitalisation, or h...

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 rad...

Importance: Physical 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...

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...

Background Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, rare during childhood. MS variations, like tumefactive MS and Balo concentric sclerosis, constitute puzzling to treat diagnostic dilemmas for pediatric patients. Differential diagnosis, mainly from brain tumors, is an absolute necessity. In addition, apart...

Purpose The present study aims to investigate the occurrence and severity of HRCT abnormalities in symptomatic never-smokers, passively exposed to cigarette smoke. Materials and methods A total of 135 never-smokers with respiratory symptoms, without underlying lung disease, underwent paired inspiratory–expiratory HRCT and completed the secondhand...

Pediatric neuroradiology is a subspecialty within radiology, with possible pathways to train within the discipline from neuroradiology or pediatric radiology. Formalized pediatric neuroradiology training programs are not available in most European countries. We aimed to construct a European consensus document providing recommendations for the safe...

Introduction: 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. Case presentation: We report the case of a toddler who presented wit...

Encephalitis in children may lead to adverse outcomes and long-term neurodevelopmental sequelae. The prompt identification of the causative agent is important to guide proper management in cases with encephalitis; however, the etiology often remains undetermined. The use of polymerase chain reaction (PCR) analysis in the cerebrospinal fluid (CSF) h...

Objective Super-refractory status epilepticus (SRSE) is associated with significant morbidity and mortality in children. We explored the clinical spectrum, specific characteristics, and outcome in SRSE patients admitted in a pediatric intensive care unit (PICU) and investigated how well current diagnostic or treatment modalities perform compared to...

Submission: 30/ Neuroblastic tumours constitute a heterogenous group of tumours with diverse presentation, variable malignant behaviour and prognosis. Image Defined Risk Factors (IDRFs) have been described in the International Neuroblastoma Risk Group Staging System (INRGSS). IDRFs refer to compartmental involvement, the effect of masses to vital o...

Here we describe a cohort of 10 unrelated Greek patients (4 females, 6 males; median age 6.5 years, range 2-18 years) with heterogeneous epileptic syndromes deemed genetic in origin. In these patients, causative genetic variants, including two novel ones, were identified in 9 known epilepsy-related genes through Whole Exome Sequencing. A patient wi...

Visceral herpes zoster following reactivation of dormant varicella-zoster virus can rarely occur, usually in highly immunosuppressed patients, and may present with abdominal pain without the relevant rash. In the absence of skin manifestations, diagnosis of visceral herpes zoster is extremely difficult, while computed tomography may reveal isolated...

Purpose To determine the radiation burden to infants undergoing voiding cystourethrography (VCUG) in a single institution and investigate the effect of shifting from analogue to digital imaging that allowed the use of a radiography-free examination protocol. Methods Anthropometric and exposure data were prospectively collected for 35 consecutive i...

Purpose: Respiratory failure (RF) is one of the most common reasons for hospitalization in pediatric intensive care units (PICU). We propose a radiography-based severity score for the assessment of children with RF and investigate the possible associations with severity indices and outcome. Materials and Methods: Children with acute RF admitted in...

Background: Primary splenic pregnancy is a rare entity, usually treated with splenectomy. Case presentation and review of the literature: We report the first case of conservative management of splenic pregnancy with selective embolization and intramuscular methotrexate administration. Postoperative treatment was uneventful. We have further syste...

Gastrointestinal tract (GIT) perforation is a common medical emergency associated with considerable mortality, ranging from 30 to 50%. Clinical presentation varies: oesophageal perforations can present with acute chest pain, odynophagia and vomiting, gastroduodenal perforations with acute severe abdominal pain, while colonic perforations tend to fo...

Aim Diagnosis and management of complicated mastoiditis in childhood are still controversial. We investigated the clinical manifestations, evaluation and management of children with mastoiditis complicated with cerebral venous sinus thrombosis. Methods Retrospective cohort study that included all children admitted for acute mastoiditis over the la...

Aim: Diagnosis and management of complicated mastoiditis in childhood are still controversial. We investigated the clinical manifestations, evaluation and management of children with mastoiditis complicated with cerebral venous sinus thrombosis. Methods: Retrospective cohort study that included all children admitted for acute mastoiditis over the l...

Ultrasonography (US) is one of the most common diagnostic imaging tests in children. During the coronavirus disease 2019 (COVID-19) pandemic, it is important to operate with a plan designed to protect health care workers, to prevent transmission of infection from child and parents to another child or an accompanying person in the US suite, and to s...

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 fo...

Acute Q fever is usually asymptomatic or is associated with a mild self-limited course and a favorable outcome. The occurrence of endocarditis during acute infection by Coxiella burnetii is an emerging clinical entity observed in adults that has been attributed to an autoimmune complication of early infection. Herein, we report the first case of a...

During the outbreak of the COVID-19 pandemic, guidelines have been issued by international, national and local authorities to address management and the need for preparedness. Children with COVID-19 differ from adults in that they are less often and less severely affected. Additional precautions required in the management of children address their...

Ultrasonography (US) is the imaging method of choice for evaluating the pediatric thyroid gland, complemented by scintigraphy and thyroid function tests, especially when evaluating children with suspected congenital hypothyroidism, goiter, infectious or autoimmune diseases, or neoplasm. Diagnostic considerations in newborns with congenital hypothyr...

Purpose: The purpose is to investigate cardiac magnetic resonance and laboratory findings in patients with clinically suspected acute myocarditis and re-assess the evolution of findings in relation to clinical parameters and smoking habits. Methods: We prospectively analyzed 68 consecutive patients (4 females, 64 males, median age 25 years) at base...

Spontaneous pneumomediastinum in the term newborn is relatively rare. We aim to emphasize the significance of Radiographic and CT features of spontaneous pneumomediastinum. We present an otherwise healthy 4-hour-old male, born by a caesarean section, presenting with sudden bulging of the left hemithorax and moderate respiratory distress. Chest radi...

The original version on this paper contained an error. The COI statement is incorrectly presented.

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term...

Cavitary pulmonary tuberculosis in children is uncommon in areas with a low tuberculosis burden. We present two cases in an 11-year old immunocompetent girl and an 8-year old immunocompromised boy. Both children were immigrants. No other cavitary tuberculosis cases have been observed in a population of 103,781 children in Crete, Greece for the past...

Purpose Tο fabricate a tissue-mimicking phantom simulating the MR relaxation times of neonatal gray and white matter at 1.5 T, for the optimization of clinical Τ1 weighted (T1w) and T2 weighted (T2w) sequences. Methods Numerous agarose gel solutions, doped with paramagnetic Gadopentetic acid (Gd-DTPA) ions, underwent quantitative relaxometry with...

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term...

Purpose To develop an anthropomorphic neonatal 3D printed head phantom which could be used as a quality assurance means for the overall optimization of the neonatal brain clinical T1-weighted (T1w) and T2-weighted (T2w) MRI pulse sequences. Materials and Methods Tissue-mimicking materials simulating the MR relaxation times of gray and white matter...

Purpose To optimize clinical T1w and T2w sequences at multiple 1.5T MRI systems of different vendors, using an in house developed phantom simulating neonatal brain relaxometric characteristics. Materials Methods A neonatal brain phantom, fabricated from paramagnetically doped agarose gel solutions, underwent quantitative MR relaxometry utilizing a...

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. Ultras...

Submission: Neuroblastic tumours constitute a heterogenous group of tumours with diverse presentation, variable malignant behaviour and prognosis. Image Defined Risk Factors (IDRFs) have been described in the International Neuroblastoma Risk Group Staging System (INRGSS). IDRFs refer to compartmental involvement, the effect of masses to vital organ...

Purpose: 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 i...

Objectives: To compare a simplified ultrasonographic (US) protocol in 2 patient positions with the same-positioned comprehensive US assessments and high-resolution computed tomographic (CT) findings in patients with idiopathic pulmonary fibrosis. Methods: Twenty-five consecutive patients with idiopathic pulmonary fibrosis were prospectively enro...

Polyostotic bone and bone marrow lesions in children may be due to various disorders. Radiographically, lytic lesions may become apparent after loss of more than 50% of the bone mineral content. Scintigraphy requires osteoblastic activity and is not specific. MRI may significantly contribute to the correct diagnosis and management. Accurate interpr...

Objectives: To compare lung ultrasonography (US) in the sitting or supine positions and the lateral decubitus position, with regard to the feasibility, duration, patient convenience, and assessment of B-lines, in patients with idiopathic pulmonary fibrosis. Methods: Twenty consecutive patients with idiopathic pulmonary fibrosis were prospectivel...

A 7.5-year-old previously healthy boy presented with progressively persisting headaches and acute blindness. Ophthalmologic examination disclosed visual acuity of 1/10, diminished colour vision and bilateral florid papilloedema. MR venography showed acute cerebral venous sinus thrombosis (CVST), (figure 1) and MRI showed signs of intracranial and o...

Objectives: To investigate the efficacy and safety of anti-TNF-α agent treatment compared to non-biologic DMARDs in rheumatoid arthritis patients. Methods: 82 consecutive patients, 29 males, 53 females, aged 42-79, diagnosed with RA and suitable for anti-TNF-α treatment composed two study groups: 42 with pre-existing rheumatoid arthritis-related...

This study investigated the effect of bismuth shielding on thyroid dose and image quality in paediatric neck multidetector computed tomography (MDCT) performed with fixed tube current (FTC) and automatic exposure control (AEC). Four paediatric anthropomorphic phantoms representing the equivalent newborn, 1-, 5- and 10-y-old child were subjected to...

The aim of this study was to determine the location of radiosensitive organs in the interior of four pediatric anthropomorphic phantoms for dosimetric purposes. Four pediatric anthropomorphic phantoms representing the average individual as newborn, 1-year-old, 5-year-old and 10-year-old child underwent head, thorax and abdomen CT scans. CT and MRI...

Acute focal bacterial nephritis (AFBN), renal abscess and pyonephrosis are uncommon and not fully addressed forms of urinary tract infection (UTI) which may be underdiagnosed without the appropriate imaging studies. Here, we review the characteristics and outcome of these renal entities in children managed at a single medial centre. The medical fil...

The aim of this study is to evaluate the potential effect of varicocele in the hormonal and clinical profile of adolescents. Twenty adolescents at Tanner stage 4-5 with left varicocele were studied and compared with a control group of 20 healthy adolescents. All patients underwent ultrasonographic testicular volumetry as well as hormonal evaluation...

We present a case of primary renal angiosarcoma. We focus on the characteristic striated pattern of the tumor on T2-w MR sequence as well as on other radiological features and correlate them with the pathologic findings. A review of the imaging characteristics of cases published in the literature was subsequently performed.

We present a case of primary renal angiosarcoma. We focus on the characteristic striated pattern of the tumor on T2-w MR sequence as well as on other radiological features and correlate them with the pathologic findings. A review of the imaging characteristics of cases published in the literature was subsequently performed.

Objectives: The aim of the present phantom study was to investigate the effect of x-ray tube parameters and iodine concentration on image quality and radiation dose in cerebral computed tomographic (CT) angiographic examinations of pediatric and adult individuals. Materials and methods: Four physical anthropomorphic phantoms that represent the a...

We present a unique case of life-threatening pneumococcal meningitis complicated by vasculitis in a fully vaccinated 4-year-old female with the heptavalent conjugate vaccine for Streptococcus pneumoniae (PCV7). Serotype 23F was isolated in both blood and cerebral spinal fluid (CSF) samples. Pulses of methylprednisolone were promptly initiated in ad...

Bacterial meningitis is a complex, rapidly progressive disease in which neurological injury is caused in part by the causative organism and in part by the host's own inflammatory responses. We present the case of a two-year-old Greek girl with pneumococcal meningitis and an atypical curvilinear-like skin eruption, chronologically associated with ce...

Cardio-facio-cutaneous (CFC) syndrome is characterized by a variable degree of cognitive impairment, and multiple congenital anomalies including characteristic facies, cardiac, and ectodermal abnormalities. CFC syndrome is caused by mutations in the genes BRAF, MEK1, or MEK2. Here we provide a follow-up report on two patients presenting distinct fa...

CT scans of the brain, sinuses and petrous bones performed as the initial imaging test for a variety of indications have the potential to expose the eye-lens, considered among the most radiosensitive human tissues, to a radiation dose. There are several studies in adults discussing the reduction of orbital dose resulting from the use of commerciall...

Introduction Abdominal injuries in abused children are less common than musculoskeletal and craniocerebral injuries; however they carry high mortality and morbidity rates. In every case of trauma, regardless of aetiology, radiologists are responsible for the documentation and evaluation of injuries. Injuries Any abdominal injury pattern maybe obser...

We describe a new family with Adams-Oliver syndrome (AOS). The propositus is a 14-month-old boy presenting with aplasia cutis congenita, distal limb transverse defects, growth retardation, and a wide atrial septal defect. Central nervous system abnormalities included central hypotonia, and magnetic resonance imaging (MRI) findings consistent with p...

P>The patient, the fifth child of a phenotypically healthy family, was born at 39 weeks’ gestation following an uncomplicated pregnancy, with a birth weight of 3,750 kg. There was no history of maternal diabetes. Neonatal course was uneventful. He was referred at 4 years with nystagmus and strabismus, which were first diagnosed at 6 months. Fundusc...

Primary hepatic lymphomas are exceedingly rare in children, with less than a dozen cases described to date. The authors present an 8.5-year-old boy with Burkitt lymphoma of the liver who had isolated multifocal liver lesions that exhibited a multilayered progressive enhancing pattern on MRI. Diagnosis was achieved after laparotomy and incisional bi...

We report an aggressive tumour in a 5-year-old girl causing facial disfigurement. Imaging confirmed a solid, diffusely enhancing mass at the right internal pterygoid muscle, infiltrating the adjacent bone. Surgical excision and reconstruction of the mandible were performed. Histology revealed aggressive infantile fibromatosis. No recurrence was not...

Dysphagia is a symptom associated with various diseases of the upper gastrointestinal and respiratory tract, and it may be the presenting symptom of numerous tumors of the head and neck. Plexiform neurofibromas (PNFs) are benign tumors of the peripheral nerves and connective tissue, which are usually associated with neurofibromatosis type 1. We pre...

Sports injuries may be unique in childhood and adolescence due to the inherent weakness of the growing skeleton at specific sites, mainly the cartilaginous parts. Many injuries are predictable based on the known mechanism of injury encountered in certain sports. There are two distinct patterns of injury in sports; acute, and chronic or overuse. Ima...

This study included all 18 cases of children hospitalized for encephalitis in the referral university hospital of Heraklion, Crete, Greece, during the 5-year period from 2000 to 2004. Encephalitis was attributed to viral infection (echovirus, herpes simplex virus 1, varicella-zoster virus, cytomegalovirus, and influenza A) in eight children and to...

Oedema is an uncommon complication of insulin therapy, which has only rarely been reported in childhood. We describe a case of a 12-year-old girl with newly diagnosed type 1 diabetes, who presented with oedema of the lower extremities and periorbitally, one day after the initiation of insulin treatment. Other causes of oedema were excluded. Followi...

Aim of this study is to illustrate the multidetector row computed tomographic findings related to oesophageal injuries and their significance for therapeutic decisions. From April 2002 to April 2005 we studied 16 patients with suspected oesophageal injury. Ten patients underwent standard chest radiograph, while five patients with suspected foreign...

The optimal anticoagulation following Fontan operation and its modifications remain controversial and it is even less well defined as regards patients with inherited thrombophilia. We present a case of a child with bidirectional Glenn anastomosis for double inlet left ventricle that suffered a stroke despite aspirin prophylaxis; the patient was com...

The purpose of this study was to investigate the effect of z overscanning on eye lens dose and effective dose received by pediatric patients undergoing head CT examinations. A pediatric patient study was carried out to obtain the exposure parameters and data regarding the eye lens position with respect to imaged volume boundaries. This information...

The aim of the current study was to (a) provide normalized dose data for the estimation of the radiation dose from upper gastrointestinal tract contrast (UGIC) studies carried out to infants and (b) estimate the average patient dose and risks associated with radiation from UGIC examinations performed in our institution. Organ and effective doses, n...

The purpose of this study was to determine the gonadal dose, effective dose and relevant radiogenic risks associated with pediatric patients undergoing voiding cystourethrography (VCUG). Exposure parameters were monitored in 118 consecutive children undergoing VCUG. The entrance surface dose (ESD) was determined by thermoluminescent dosimeters (TLD...

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. Ent...

A newborn girl with histologically confirmed epulis presented with a 2.6-cm mass protruding from her mouth. An ultra-sound study performed in antenatal week 25 was unremarkable. Postnatal ultrasound showed a mass, hyperechoic centrally, hypoechoic peripherally , containing crowded branching vessels. MRI revealed a non-enhancing gingival mass exhibi...

Our aim in the study was to assess the eye lens dose reduction resulting from the use of radioprotective bismuth garments to shield the eyes of pediatric patients undergoing head CT. The Monte Carlo N-particle transport code and mathematical humanoid phantoms representing the average individual at different ages were used to determine eye lens dose...

Imaging findings in a 52-year-old woman with proven proliferative myositis are described. US revealed preservation of continuous muscle bundles and patchy areas of hyperechogenicity, containing hypoechoic lines. MRI showed at T2-w sequences an ill-defined, hyperintense, intramuscular lesion, containing isointense lines. Subtotal enhancement, a none...

Limited data exist in the literature concerning the patient-effective dose from paediatric skull radiography. No information has been provided regarding organ doses, patient dose during PA skull projection, risk of cancer induction and dose to comforters, i.e. individuals supporting children during exposure. To estimate patient-effective dose, orga...

Children are more vulnerable to the late somatic effects and genetic effects of radiation than adults; therefore, every effort should be made to keep the dose as low as reasonably achievable, trying to retrieve the best possible information when performing indicated diagnostic tests. Minimizing radiation doses should be a concept applied in a chain...

We describe the case of an 8-year-old girl without neurofibromatosis, who presented with total loss of vision on the left eye, due to a chiasmatic mass with imaging characteristics of glioma, accompanied by a second asymptomatic mass in the middle cranial fossa, along the intracranial route of the right trigeminal nerve. The patient received a tota...

Salmonella virchow is generally considered to be one of the less invasive non-typhoidal Salmonellae species; however, several invasive cases have previously been reported. We report 3 cases of otherwise healthy children with S. virchow bacteraemia, monoarthritis and prevertebral abscess, only 1 of whom had previously had gastroenteritis. All 3 chil...

A case of recurrent abdominal wall abscess following percutaneous cholecystostomy (PC) is presented. Transperitoneal PC was performed in an 82-year-old female with calculous cholecystitis. Symptoms resolved and the catheter was removed 29 days later. The patient came back 5 months later with a superficial abscess that was drained and 8 months post...

Malignant peritoneal mesothelioma is a rare disease associated with mild, nonspecific abdominal symptoms and a wide spectrum of imaging findings, with thickened mesentery and peritoneum being the most common ones. A case of a malignant peritoneal mesothelioma presenting with manifestations of pulmonary disease is reported. Imaging evaluation reveal...

Objective. To compare fluoroscopic freeze-frame digital images with conventional 105-mm spot films during voiding cystourethrography (VCUG) with regard to diagnostic quality and radiation dose. Materials and methods. VCUG was performed on 57 consecutive children by a commercially available fluoroscopic digital system. Both freeze-frame digital imag...

Our goal was to assess the incidence of retropsoas positioned large or small bowel in the population and to examine factors predisposing to its formation. The presence of retropsoas positioned bowel was retrospectively studied in 1,852 abdominal CT examinations of 1,055 men and 797 women, 648 younger and 1,204 older than 50 years. All examinations...

Two adults and a child with acute abdomen and surgically confirmed torsion of wandering spleen are presented. Computed tomography provided a spectrum of findings including an ovoid or comma-shaped abdominal mass, hypertrophy of the liver's left lobe, a whirled appearance of hyperdense, nonenhancing splenic vessels, and an enlarged spleen, exhibitin...

To assess the shortest time for catheter removal with regard to the transhepatic or transperitoneal approach in patients undergoing percutaneous cholecystostomy (PC). In this prospective study, 40 consecutive high-risk patients with acute cholecystitis (calculous, n = 22; acalculous, n = 18) underwent PC by means of a transhepatic (n = 20) or trans...

The purpose of our study was to examine variations in normal splenic size in relation to age, gender and body habitus in vivo, and to determine normative data for splenic volume on CT. The width (W), length (L), thickness (Th), cross-sectional areas and volume (Vol) of the spleen were obtained from abdominal CT examinations of 140 patients who unde...

Hepatodiaphragmatic interposition of the colon (HDIC) has been previously evaluated with chest radiography (CR) of patients examined in an erect position. In this work the presence of HDIC was assessed in patients who underwent CT in the supine position. In 1,440 patients, 806 men and 634 women, 19-83 years old subjected to CR and abdominal CT for...