Aim: To investigate the value of ElastPQ measurement for differential diagnosis of benign and malignant focal liver lesions (FLLs) by using histologic results as a reference standard. Material and methods: A total of 154 patients were included. ElastPQ measurement was performed for each lesion in which the shear wave speed (SWS) was measured. The difference in SWS and SWS ratio of FLL to surrounding liver were evaluated, and the cut off value was investigated. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance. Histology as a gold standard was obtained by surgery in all patients. Results: A total of 154 lesions including 129 (83.7 ) malignant FLLs and 25 (16.3 ) benign ones were analysed. The SWS of malignant and benign FLLs was significantly different, 2.77±0.68 m/s and 1.57±0.55 m/s (p<0.05). The SWS ratio of each FLL to surrounding liver parenchyma was 2.23±0.49 for malignant and 1.14±0.36 for benign FLLs (p<0.05). The cut off value for differential diagnosis was 2.06 m/s for SWS and 1.67 for SWS ratio. Conclusions: ElastPQ measurement provides reliable quantitative stiffness information of FLLs and may be helpful in the differential diagnosis between malignant and benign FLLs.