Abstract: Background and purpose: Primary liver cancer occurs mostly on the basis of chronic hepatitis and liver cirrhosis. It generally develops through a series of processes, such as cirrhotic nodule (CN) and dysplastic nodules (DN), and finally evolves into hepatocellular carcinoma (HCC). In this study, contrast-enhanced ultrasound (CEUS) was used to monitor patients with cirrhotic nodules regularly, and the value of CEUS was evaluated in the early diagnosis of HCC. Methods: From January 2007 to December 2017, 9 550 patients with chronic liver cirrhosis who treated in Zhongshan Hospital, Fudan University were enrolled, among them 392 patients with 551 intrahepatic nodules were examined every 3 to 6 months. The perfusion features on CEUS were analyzed and compared with the results of pathological and imaging diagnosis. Results: Among 551 intrahepatic nodules, there were 55 small HCCs (less than 2 cm), 19 DNs and 477 CNs confirmed clinically. Conventional ultrasound showed hypoechogenic nodules in 61.6% (294/477) of CNs, 78.9% (15/19) of DNs and 67.3% (37/55) of HCCs. On CEUS, the most common perfusion features of nodules in three vascular phases were iso-iso-iso enhancement pattern in CN (89.5%, 427/477), hypo-iso-iso pattern in DN (52.6%, 10/19) and hyper-iso-iso enhancement and hyper-iso-hypo enhancement patterns in small HCC (85.5%, 47/55) compared with liver parenchyma. The diagnostic accuracy of CEUS was 93.3%, 78.9% and 85.5% for CN, DN and HCC, respectively. Conclusion: CEUS reflects the perfusion features of CN, DN and HCC objectively. Regular monitoring of cirrhotic nodules with CEUS makes prompt warning and early diagnosis of small HCC possible in clinical setting.