Objective To compare the clinical value between real-time ultrasound elastography (RTE) and magnetic resonance diffusion weighted imaging (DWI) in the grading of liver fibrosis in patients with chronic hepatitis B (CHB). Methods 88 cases of patients with CHB were selected as subjects, and they were examined by RTE and DWI. Based on the pathological findings of liver biopsy, 88 patients were divided into S0 group, grade S1-S2 group and grade S3-S4 group. The RTE indexes [elasticity score, shear wave velocity (SWV)] and DWI index [apparent diffusion coefficient (ADC)] were compared among the three groups. The correlations between grade of liver fibrosis and elasticity score, SWV value and ADC value in patients with CHB were analyzed by Spearman correlation coefficient analysis. Results The elasticity scores and SWV values of the three groups showed that the grade S0 group < grade S1-S2 group < grade S3- S4 group (P< 0.05) while ADC values showed that the grade S0 group > grade S1-S2 group > grade S3-S4 group(P<0.05). Spearman correlation coefficient analysis showed that grade of liver fibrosis in patients with CHB was positively correlated with elasticity score and SWV value, and negatively correlated with ADC value(P<0.05). Conclusion The elasticity score, SWV value and ADC value of RTE are closely related to the grade of liver fibrosis in patients, which can be used for differential diagnosis.