BACKGROUND: The purpose of this study was to investigate the values of contrast-enhanced ultrasound (CEUS) in the diagnosis and differential diagnosis of hyperechoic liver lesions. MATERIAL AND METHODS: The CEUS findings of 102 patients with hyperechoic liver lesions identified by 2-dimensional ultrasound in the Affiliated Tumor Hospital of Guangxi Medical University were reviewed and analyzed. RESULTS: A total of 135 lesions were analyzed, of which malignant lesions were found in 72 patients and benign lesions in 63, with a CEUS accuracy rate of 91.11%, which was significantly higher than that of conventional ultrasound (74.81%; P<0.05). CONCLUSIONS: CEUS can improve the accuracy rate of ultrasonography in the diagnosis and differential diagnosis of hyperechoic liver lesions.