AbBSTRACT objective To explore the application value of real-time tissue elastography in the diagnosis of hepatic alveolar echinococcosis. Methods 95 liver lesions in 95 cases were scaned with conventional ultrasonography and elastography, record the size of the lesions and assessed with grade scores respectively. Results on ultrasound were compared with those on operation or pathology. Results Under the same cross section, in the elastography, the lesions area, perimeter and volume were significantly greater than the measurement of the lesions in conventional ultrasonic（t= -3.164、-2.292、-2.359；-4.388、-2.442、-4.559；P= 0.005、0.033、0.029；0.000、0.018、0.000）. There was statistical significance between primary hepatic carcinoma and hepatic alveolar echinococcosis on the distribution of elasticity grade(t= 2.640；P= 0.013), The elasticity grade of hepatic alveolar echinococcosis was significantly greater than it of the liver hemangioma(t= 9.136; P< 0.001). Conclusion Elastography can well distinguish the hardness of primary hepatic carcinoma, hepatic alveolar echinococcosis and the liver hemangioma, play an effective auxiliary function in the diagnosis of hepatic alveolar echinococcosis.