Abstract Background: Diagnosis of the stage of liver fibrosis is essential for making a prognosis regarding the development of cirrhosis and hepatocellular carcinoma; and surveillance in patients with chronic HCV. Hitachi Real-time Elastography (HI-RTE) showed promising results as an effective measure for diagnosis of liver fibrosis, regardless of the stage, in patients with chronic viral hepatitis. Aim of Study: We aimed at evaluating the efficacy of (HI-RTE) in staging of liver fibrosis in chronic HCV patients compared to liver biopsy. Results of FIB-4 and APRI scores as non-invasive measures for assessment of liver fibrosis are also discussedin this report. Patients and Methods: A total of 194 chronic HCV patients were recruited and subjected to baseline HCV pre-treatment assessment, including Liver function tests, complete blood picture, prothrombin time, serology for hepatitis B, HCV-RNA, and abdominal ultrasound examination. FIB-4 and APRI scores were calculated. HI-RTE, and finally, ultrasound guided liver biopsy, were performed for every patient. Results: AUROCs of LFI, FIB-4 and APRI were 0.721, 0.774, and 0.744 respectively for detecting significant liver fibrosis (F2), while in predicting advanced liver fibrosis (F3), AUROCs were 0 734, 086, and 0 803 r spectively, whereas, for detection of liver cirrhosis (F4), AUROCs were 0.841, 0.927, and 0.863 respectively. Cut-off values of LFIfor predicting significant fibrosis (F 2), advanced fibrosis (F3)113 andliver cirrhosis (F=4), were 2.67, 2.97 and 3.35 respectively. Conclusion: Liver fibrosis index measured by real time elastography (HI-RTE) performs well and is clinically appli-cable for evaluating the degree of liver fibrosis in chronic HCV patients.