Objective To investigate the clinical significance of image-guided transient elastography FibroTouch with fat attenuation parameter (FAP) in the diagnosis of fatty liver disease. Methods A total of 1080 persons who underwent physical examination in The First Affiliated Hospital of China Medical University from January to December, 2014 were enrolled, and liver FAP, the results of color Doppler ultrasound for the liver, and liver/spleen CT ratio on computed tomography (CT) scan for the liver were collected and analyzed. The Kruskal-Wallis H test was applied for comparison of continuous data between groups, and the Kappa consistency coefficient and receiver operating characteristic curve were used to investigate the consistency between FAP and the results of color Doppler ultrasound for the liver or liver/spleen CT ratio on CT scan for the liver in the diagnosis of fatty liver disease and their diagnostic values. Results Liver ultrasound found 336 patients (31.11%) without fatty liver disease and 744 patients (68.89%) with fatty liver disease; with reference to the results of ultrasound, the sensitivity and specificity of FibroTouch were 80.5% and 75.3%, respectively. Liver CT found 821 patients (76.02%) without fatty liver disease (grade 0) and 259 patients with fatty liver disease, among whom 216 had mild fatty liver disease (grade 1), 34 had moderate fatty liver disease (grade 2), and 9 had severe fatty liver disease (grade 3); with reference to the results of liver CT, the sensitivity and specificity of FibroTouch were 95.4% and 47.0%, respectively, and the sensitivity and specificity of ultrasound were 93.1% and 36.8%, respectively. As for the diagnosis of fatty liver disease, the results of FibroTouch had a higher consistency with ultrasound results (Kappa coefficient=0.597, P＜0.0001), and a lower consistency with CT results (Kappa coefficient=0.113, P＜0.0001). Conclusion FibroTouch has the advantages of high accuracy, easy operation, noninvasiveness, and low cost, and therefore it is a promising imaging method for the diagnosis of fatty liver disease. [ABSTRACT FROM AUTHOR]