Abstract: Objective To explore the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of intrahepatic cholangiocarcinoma (ICC), hepatocellular carcinoma (HCC), and hepatic hemangioma (HH). Methods 157 patients with liver space occupying lesions were selected, including 41 patients with ICC, 50 patients with HCC, and 66 patients with HH. The differences in CEUS image characteristics and quantitative parameters were pairwise compared. Results The proportions of irregular morphology, blurred lesion boundaries, uneven enhancement in arterial phase, and low enhancement in portal vein phase in ICC were 65.85%, 53.66%, 90.24%, and 100.00%, respectively, which were significantly higher than those with HCC and HH (all P<0.05). The proportion of delayed low enhancement in ICC and HCC was 100.00% and 94.00%, respectively, which were significantly higher than that in HH (both P<0.05). The rates of blurred border and low enhancement of portal vein in HCC were 12.00% and 68.00%, respectively, which were significantly higher than those in HH (both P<0.05). The initial time of enhancement, the time of reaching peak in ICC were (8.89±1.95) s and (18.65±7.11) s, respectively, which were significantly faster than those in HCC and HH (all P<0.05). The initial time of enhancement, time of reaching peak in HCC were (10.82±2.21) s and (22.15±8.36) s, respectively, which were significantly faster than those in HH (all P<0.05). The area under the ROC curves for differential diagnosis of ICC and HH by the onset time and peak time were higher than 0.800 (P<0.05). Conclusion The CEUS image characteristics of ICC, HCC, and HH are different, and CEUS can provide quantitative parameters for differential diagnosis.

Key words: Contrast-enhanced ultrasound, Intrahepatic cholangiocarcinoma, Hepatocellular carcinoma, Hepatic hemangioma, Differential diagnosis