Drug-induced liver injury (DILI) is one of the most challenging forms of liver disorder. We aimed to use ultrasound dual elastography, by combining strain and shear wave imaging, to noninvasively assess liver inflammation and injury severity of DILI.

291 DILI patients were included in the prospective multicenter study and divided into training and validation cohorts. All patients received liver biopsy and dual elastography examination. Liver inflammation grading (G0-4) and fibrosis staging (F0-4) were considered as the gold standard of liver injury and G+F ≥ 5 was defined as severe liver injury. Indexes of dual elastography and serological indicators (DESI) were selected and analyzed with multivariable logistic regression to build DESI models for evaluating liver inflammation, and the C score model was built with the same method for diagnosing severe liver injury.

Areas under the receiver operating characteristic curve (AUCs) of the DESI model to assess liver inflammation ≥ G2 were 0.887 and 0.868 in training and validation cohorts, respectively. AUCs of the DESI model in diagnosing ≥ G3 were 0.893 and 0.896 in the two cohorts, respectively. The C score accurately assessed severe liver injury with AUCs of 0.909 and 0.885 in two cohorts. Of the 87 patients with mild clinical severity, 10 (11.49%) had severe pathological injury, which could be identified by C score.

Dual elastography demonstrated high performance in diagnosing liver inflammation and identifying severe pathological liver injury of DILI, making up for the deficiency of serological indicators alone for evaluating DILI severity.

To investigate the ultrasound features of hepatic reactive lymphoid hyperplasia (HRLH) and primary hepatic lymphoma (PHL), and determine the value of ultrasound on the diagnosis and differentiation of them.

The ultrasound findings of 11 HRLH lesions and 14 PHL lesions from April 2011 to September 2020 were retrospectively analyzed. The conventional ultrasound and contrast-enhanced ultrasound (CEUS) manifestations of them were compared.

HRLH showed significant female preference than PHL (100% and 64.3%) (P = 0.046). There were no significant differences of other demographics between HRLH and PHL patients. On conventional ultrasound, the diameter of HRLH (16.5 ± 3.8 mm) was significantly smaller than that of PHL (48.3 ± 36.2 mm) (P = 0.008), and a regular shape was seen more frequently in HRLH (90.9%) than that in PHL (50%) (P = 0.038). There were no significant differences of other indexes between HRLH and PHL. On CEUS, both HRLH and PHL presented arterial enhancement and washout in early portal phase. But rim enhancement at the beginning of washout was seen more frequently in HRLH (90.0%) than that in PHL (33.3%) (P = 0.036), and HRLH usually displayed hyperenhancement (100%) in arterial phase while PHL could be hypoenhancement (16.7%), isoenhancement (33.3%) and hyperenhancement (50%) (P = 0.036).

Ultrasound can supply valuable imaging evidences for the diagnosis of HRLH and PHL. The ultrasound features including size, shape, degree of arterial phase enhancement and rim enhancement at the beginning of washout can be used for the differentiation of HRLH and PHL.