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Background Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram readers to learn to effectively interpret abMRI. The purpose of this study was to examine the diagnostic accuracy of mammogram readers to interpret abMRI after a single day of standardised small-group training and to compare diagnostic performance of mammogram readers experienced in full-protocol breast MRI (fpMRI) interpretation (Group 1) with that of those without fpMRI interpretation experience (Group 2). Methods Mammogram readers were recruited from six NHS Breast Screening Programme sites. Small-group hands-on workstation training was provided, with subsequent prospective, independent, blinded interpretation of an enriched dataset with known outcome. A simplified form of abMRI (first post-contrast subtracted images (FAST MRI), displayed as maximum-intensity projection (MIP) and subtracted slice stack) was used. Per-breast and per-lesion diagnostic accuracy analysis was undertaken, with comparison across groups, and double-reading simulation of a consecutive screening subset. Results 37 readers (Group 1: 17, Group 2: 20) completed the reading task of 125 scans (250 breasts) (total = 9250 reads). Overall sensitivity was 86% (95% confidence interval (CI) 84–87%; 1776/2072) and specificity 86% (95%CI 85–86%; 6140/7178). Group 1 showed significantly higher sensitivity (843/952; 89%; 95%CI 86–91%) and higher specificity (2957/3298; 90%; 95%CI 89–91%) than Group 2 (sensitivity = 83%; 95%CI 81–85% (933/1120) p < 0.0001; specificity = 82%; 95%CI 81–83% (3183/3880) p < 0.0001). Inter-reader agreement was higher for Group 1 (kappa = 0.73; 95%CI 0.68–0.79) than for Group 2 (kappa = 0.51; 95%CI 0.45–0.56). Specificity improved for Group 2, from the first 55 cases (81%) to the remaining 70 (83%) (p = 0.02) but not for Group 1 (90–89% p = 0.44), whereas sensitivity remained consistent for both Group 1 (88–89%) and Group 2 (83–84%). Conclusions Single-day abMRI interpretation training for mammogram readers achieved an overall diagnostic performance within benchmarks published for fpMRI but was insufficient for diagnostic accuracy of mammogram readers new to breast MRI to match that of experienced fpMRI readers. Novice MRI reader performance improved during the reading task, suggesting that additional training could further narrow this performance gap.

Most aneurysms adequately occluded at 6 months did not show evidence of late recurrence. Large and wide-neck aneurysms are, however, at greater risk of later recurrence.

lateral quadrant of the pituitary fossa fenestration. This was controlled with Surgicel and surgical packs were inserted. Then, 3 days post-operatively, the patient was investigated with magnetic resonance angiography (MRA) which demonstrated a small left cavernous ICA pseudoaneurysm (Fig. 1a). Digital subtraction angiography (DSA) confirmed the presence of 4 × 3 mm aneurysm with a defined neck arising from the distal cavernous carotid just before the second genu (Fig. 1b). The aneurysm was selectively catheterised using an Echelon 10 microcatheter (Covidien, USA). A series of soft and ultrasoft coils (Boston, now Stryker, USA) were sequentially deployed into the pseudoaneurysm achieving complete occlusion (Fig. 2).Follow-up MRA performed 2 weeks later demonstrated a tiny neck remnant and repeat MRA at 6 weeks showed complete obliteration of the aneurysm. DSA at 4 months confirmed satisfactory occlusion (Fig. 3). The patient remains well 5 years after the surgery and intervention. Case 2A 43-year-old man with acromegaly underwent endoscopic transsphenoidal resection of a pituitary macroadenoma. Intra-operatively, brisk bleeding was encountered from a vessel arising from the medial aspect of left internal carotid artery at the junction of the dura and cavernous sinus. This was controlled with bipolar coagulation and surgical packs. On the second post-operative day the patient developed a left third nerve palsy and left retro-orbital discomfort. Computed tomography angiography (CTA) demonstrated a left parasellar haematoma but no vascular lesion. Formal DSA demonstrated mild narrowing of the cavernous ICA only (Fig. 4). On the fifth post-operative day the packs were removed and the patient was subsequently discharged. He represented Vascular complications of transsphenoidal surgery are rare [1] but are associated with significant morbidity and mortality [2]. The cavernous internal carotid artery (ICA) is most commonly injured [2]. Following initial control of haemorrhage, definitive treatment increasingly relies upon endovascular techniques aimed at preserving the parent vessel. We describe our experience managing two patients who developed pseudoaneurysms following transsphenoidal surgery. We employed unassisted coiling in one patient and coiling with flow diversion in the second. We have also reviewed the literature to explore other endovascular treatment options. Case 1A 41-year-old male presenting with a bitemporal hemianopia underwent microsurgical transsphenoidal resection of a non-functioning pituitary macroadenoma. Following dural opening, arterial bleeding was noted from the left supero-