Objective：To investigate the accuracy of ultrasonic acoustic structure quantification (ASQ) in the diagnosis of liver fibrosis in chronic hepatitis B (CHB) and its correlation with pathological stage. Methods：A total of 122 patients with CHB admitted to our hospital from August 2019 to February 2021 were included in this study. Age, sex, weight, and height were recorded and body mass index (BMI) was calculated. Blood biochemical indicators were measured. All patients received ASQ examination, and the parameter area under the red and blue curve （FD）ratio was obtained by using ASQ analysis software. METAVIR score (F0-F4) was used to evaluate the histopathological staging of liver fibrosis by ultrasound-guided puncture or partial lobectomy biopsy. Spearman rank correlation was used for correlation analysis. The addition or subtraction of 1 between sensitivity and specificity is Youden index. The greater the index is, the better the experimental effect is and the greater the authenticity is, and the optimal truncation value for prediction was determined according to the highest Yoden index of each liver fibrosis threshold: F0-F1 vs F2-F4 (≥F2), F0-F2 vs F3-F4 (≥F3), and F0-F3 vs F4 (≥F4). The diagnostic performance of ASQ parameters was evaluated using ROC curve and area under curve (AUC). The 95% confidence interval (CI) was calculated using the Woolf method. Logistic regression analysis was used to determine the independent risk factors for FD ratio. Results：The FD ratio of CHB patients ranged from 0.08 to 1.88, and the FD ratios of F0-F1, F2, F3, and F4 were (0.23±0.07), (0.31±0.09), (0.50±0.11), and (0.74±0.12), respectively. FD ratio between F0-F1 and F2, between F2 and F3, and between F3 and F4 was statistically significant (t=10.672, P = 0.012;T =12.084, P = 0.004;T =29.336, P = 0.000). The ratio of FD increased gradually with the increase of the severity of pathological stage of liver fibrosis, and the difference was statistically significant (F = 37.629, P = 0.000).. Spearman rank correlation analysis showed that the ratio of FD was positively correlated with the hiopathological stage of liver fibrosis (r = 0.71, P = 0.000), and negatively correlated with the degree of steatosis (r = -0.44, P = 0.000), but not significantly correlated with the degree of inflammatory activity (r = -0.15, P = 0.172). The AUC values of ≥F2, ≥F3 and ≥F4 in the diagnosis of hiopathological stages of liver fibrosis were 0.796, 0.805 and 0.832, respectively. The AUC values of ≥F4 were > 0.75, which had medium diagnostic value, and ≥F4 had the highest diagnostic value. The cut-off values of ≥F2, ≥F3 and ≥F4 in predicting the histopathological stage of liver fibrosis were 0.27, 0.36 and 0.59, respectively. Logistic regression analysis showed that hiopathological stage of liver fibrosis was an independent risk factor for FD ratio (β = 1.562, OR = 7.381, 95%CI = 4.097-11.053, P = 0.000). Conclusion：FD ratio can accurately evaluate the severity of liver fibrosis, and is an effective non-invasive imaging biomarker to predict the pathological stage of liver fibrosis.