Abstract

Background/Objectives: The ANALI and DiStrict scores are novel quantitative magnetic resonance cholangio-pancreatography (MRCP)-derived scoring systems designed to predict outcomes in primary sclerosing cholangitis (PSC). However, as their prognostic utility and inter-reader reproducibility are not widely validated, their utility in clinical practice is currently limited. This study aimed to assess the reproducibility and prognostic performance of the ANALI without gadolinium (ANALING) and DiStrict scores in predicting liver-related outcomes in patients with PSC. Methods: We conducted a multicentre retrospective cohort study enrolling adult patients with large-duct PSC and at least one MRCP from the time of diagnosis. MRCPs were scored by five blinded senior abdominal radiologists with inter- and intra-reader agreement assessed via intraclass correlation coefficients. Multivariate Cox proportional models were used to evaluate the prognostic value of the ANALING and DiStrict scores, with a composite endpoint of liver transplantation, hepatic decompensation, or liver-related death. Results: Eighty-nine patients with a median of 5.5 years (IQR 3.4–9.2) of follow-up were included. The ANALING score showed higher intra-reader agreement (ICC 0.87, 95% CI 0.82–0.92 vs. ICC 0.64, 95% CI 0.36–0.79) and similar inter-reader agreement (ICC 0.71, 95% CI 0.63–0.78 vs. ICC 0.67, 95% CI 0.59–0.75) compared to the DiStrict score. Only the ANALING score was associated with liver-related events, which remained significant when adjusted for age and sex (aHR 1.28, 95% CI 1.01–1.63) and MELD (aHR 1.69, 95% CI 1.22–2.34). Conclusions: The ANALING score is a reproducible, MRI-derived scoring system that is independently associated with liver outcomes and has higher intra-reader agreement compared to the DiStrict score.

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