Abstract Background: Precise estimation of the degree of liver fibrosis is essential for estimating prognosis and surveillance in patients with chronic HCV. Liver fibrosis index (LFI) measured by Hitachi Real-time Elastography (HI-RTE) ap-peared to be effective for evaluating liver fibrosis. Aim of Study: We aimed to evaluate the role of (HI-RTE) in staging of liver fibrosis in chronic HCV patients compared to liver stiffness measurement (LSM) by Fibroscan® and liver biopsy. 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. Fibroscan, HI-RTE, and finally, ultrasound guided liver biopsy, were per-formed for every patient. Results: AUROCs of LSM and LFI were 0.840 and 0.721 respectively for detecting significant liver fibrosis (F 2), while in predicting advanced liver fibrosis (F 3), AUROCs were 0.904 and 0.734 respectively, whereas, for detection of liver cirrhosis (F4), AUROCs were 0.975 and 0.841 respec-tively. Cut-off values of LFI by (HI-RTE) for predicting significant liver fibrosis (F2), advanced f brosis (F3) andliver cirrhosis (F=4), were 2.67, 2.97 and 3.35 respectively. Conclusion: HI-RTE performs well in predicting and staging liver fibrosis in chronic HCV patients, yet, Fibroscan® remains better as a non-invasive method for assessment of liver fibrosis.