Background: Non-alcoholic fatty liver disease (NAFLD) become a challenge as it`s prevalence, difficulty to diagnose and complex pathogenesis representing about 20% of common liver disorders Patients with NAFLD are at higher risk for adverse outcomes such as cirrhosis, HCC and liver-related mortality. Aim and objectives : We aim to assess the applicability and performance of real-time elastography for the diagnosis of liver fibrosis.Methods: One hundred and thirty subjects attended damanhour medical national institute hepatology and gastroenterology outpatient clinic were divided into two groups; Group (I): Hundred cases having NAFLD by ultrasound, Group (II): thirty healthy subjects as control.Results: Fibrosis stages in NAFLD patients significantly higher than in the control group diagnosed by real time elastrography (P = 0.001). There was an agreement between Realtime Elastrography and FIB-4 index and NAFLD fibrosis score 93% and 86% respectively and diagnostic performance of real time elastrography in advanced liver fibrosis ≥F3 was assessed in comparing with FIB-4 index show sensitivity 90%, specifity 93.3%, PPV 60%, NPV 98.8%, accuracy 93%, AUC0.917, 95%CI 0.81-1.0 and (p = 0.001). Conclusion : Real time elastography may be useful in diagnosis of fibrosis in non-alcoholic fatty liver disease.