Abstract: Objective To determine MRI features correlated with the clinical classification, severity, and prognosis of drug-induced liver injury (DILI) to better identify high-risk patients with DILI.Methods From January 2018 to October 2022, a total of 122 patients diagnosed with DILI were enrolled in this study, including 35 males and 87 females, aged 55 (44, 63) years. All recruited patients met the established diagnostic criteria for DILI The clinical classifications of DILI were categorized into hepatocellular, mixed, and cholestatic types; while severity as indexed as mild, moderate and severe. Patient outcomes were monitored through follow-up assessments, categorizing the clinical prognosis of DILI into remission, maintenance or progression. The MRI findings for each patient were systematically evaluated, with a particular focus on measuring the apparent diffusion coefficient (ADC). Results Of the 122 patients diagnosed with DLLI, the primary causative agents were Chinese herbal medicine (61.5%, 75 cases), western medicine (25.4%, 31 cases), a combination of both(9.0%, 11 cases), and dietary supplements (4.1%, 5 cases). The median incubation period stood at 26 (9, 48) days. The cases of helatocellular, mixed, and cholestatic types of DILI were 90(73.8%),15(12.3%), and 12(13.9%). respectively. Mild DILI was observed in 19.7%(24 cases), moderate in 68.0%(83 cases), and sever in 12.3%(15 cases). In terms of prognosis, 85.2%(104 cases) reached remission, 6.5%(8 cases) showed maintenance, and 8.2%(10 cases) progressed. The MRI findings revealed various hepatic abnormalities: unsmooth liver surface in 6 cases(4.9%), transient hepatic attenuation difference in 20.5%(25 cases), periportal edema in 55.7%(68 cases), bile duct dilatation in 7.4%(9 cases), and gallbladder wall edema in 30.3%(37 cases), and portal lymph nodes in 16.4%(20 cases). Statistical analyses showed significant differences in periportal edema, portal lymph node enlargement, and ADC values across the clinical types of DILI(P<0.05). Moreover, significant differences in liver surface roughness, transient hepatic attenuation difference, gallbladder wall edema and splenomegaly were observed between mild and severe DILI cases(P<0.05). Multivariate analysis indicated that liver surface roughness, transient hepatic attenuation difference and splenomegaly were risk factors influencing DILI severity(P<0.05). Similarly, transient hepatic attenuation difference, ascites and splenomegaly were identified as significant prognostic risk factors(P<0.05). Conclusion Peripheral edema of portal vein is found to be associated with distinct clinical subtypes of DILI. Notably, an Irregular liver surface, transient hepatic attenuation difference. and splenomegaly are identified as key factos influencing the severity of DILI in patients. Furthermore, transient hepatic attenuation difference and ascites are revealed to possess significant clinical value for the prognostic evaluation of DILI patients.

Key words: Drug-induced liver injury, Magnetic resonance imaging, Apparent diffusion coefficient, Ascites