Objective To investigate the effect of elevated alanine transaminase（ALT） levels on liver stiffness assessed by acoustic radiation force impulse（ARFI） elastography for quantitative evaluating the degree of liver fibrosis in patients with alcoholic liver disease（ALD）.Methods We included 99 patients with ALD in which liver biopsy，ARFI elastography and ALT measurements were performed.The measurements of ultrasonic elastography by ARFI technology using a ultrasonic instrument named ACUSON S2000.Referring to the histologic fibrosis stage on liver biopsy，all the ARFI values were assessed by using Receiver Operating Characteristic（ROC） curve analysis.The corresponding cut-off values，sensitivity and specificity were also calculated and compared. Results ARFI elastography correlated significantly with liver histological fibrosis（r =0.685，P < 0.001） and necroinflammatory activity（r =0.636，P < 0.001） in patients with ALD. By comparing the performance of ARFI elastography in both normal ALT level and high ALT level groups，it appears that ARFI elastography performed better for patients with normal ALT than for those with high ALT for predict severe fibrosis（≥S3） and cirrhosis（=S4）（AUROC，0.979 vs.0.837 for S≥3 and 0.981 vs.0.839 for cirrhosis，respectively） .The optimum cutoff values for ARFI elastography were1.330 m/s for S≥2，1.395 m/s for S≥3 and 1.653 m/s for S=4 when patients with elevated alanine aminotransferase（ALT） levels ； these decreased to1.237 m/s for S≥2，1.269 m/s for S≥3 and 1.413 m/s for S=4 when patients with normal ALT.Conclusion ARFI technology has potential value for quantitatme evaluation of the liver fibrosis for ALD.ARFI elastography is influenced by elevated ALT levels in ALD.