Contrast-enhanced ultrasound (CEUS) with pure blood stream contrast agents allow the study of blood supply of focal liver lesions and especially of hepatocellular carcinoma (HCC) in cirrhosis. Its sensitivity and specificity in diagnosis of small tumors is very high. This review summarizes the recent results on CEUS with SonoVue, which is one of the second generation contrast agents, in the diagnosis of early HCC in cirrhosis emphasizing its increasing role in routine clinical practice.