Aims: To compare the diagnostic performance of transient elastography (TE), supersonic shear-wave imaging (SSI), and acoustic radiation force impulse (ARFI) imaging for staging liver fibrosis and to find clinical factors which affect liver stiffness measurement (LSM) in a prospective NAFLD cohort. Methods: Ninety-four patients with histologically confirmed NAFLD were included in this prospective cohort study. For each patient, liver stiffness was measured using TE, SSI, and ARFI within 1 month of percutaneous liver biopsy. Diagnostic performance for staging liver fibrosis was evaluated using receiver operating characteristic (ROC) analysis. Clinical, laboratory, and anthropometric data using fat-amount CT and bioelectrical impedance analysis were evaluated as covariates influencing LSM by regression analyses. Results: All three LSM methods were well correlated with fibrosis stages (NASH CRN) (r= 0.416~0.532, p<0.001) and exhibited statistically similar diagnostic performance for staging fibrosis; the area under the receiver operating characteristic (AUROC) curves for TE (kPa), SSI (m/s), SSI (kPa), and ARFI (m/s) were 0.757, 0.761, 0.759, and 0.657 for diagnosing ≥F2, 0.870, 0.816, 0.809, and 0.873 for ≥F3, and 0.882, 0.900, 0.906, and 0.920 for F4, respectively (p>0.05). ARFI tended to be more specific and SSI tended to be more sensitive to differentiate each fibrosis stage with their best diagnostic performances showing the highest Youden’s index. Anthropometric data were correlated with failure or unreliability of LSM, especially for SSI LSM. In regression analysis, anthropometric data might be confounding factors for SSI LSM, while serum liver injury-related markers might be confounding factors for TE and ARFI LSM. Conclusions: Diagnostic performances of individual LSM modalities for staging liver fibrosis in NAFLD patients were not statistically significantly different. TE or ARFI might fit better for suspicion of advanced fibrosis (≥F3) in NAFLD, while TE or SSI could be more advantageous for suspicion of mild fibrosis (F0~F2) in NAFLD. Pre-LSM anthropometric evaluation may help predicting LSM reliability, especially for SSI.