Objective:The aim of this study was to evaluate the value of contrast-enhanced ultrasound (CEUS) for blood perfusion of primary liver cancer (PHC) and investigate the correlation between microvascular architecture of PHC and pathological differentiation.Methods:Two hundred and seventy-eight patients with 329 PHC lesions were examined by CEUS and analysised the contrast enhancement pattern and correlation with pathology.Results:1.CEUS patterns of PHC:71.7% (236/329) showed “swift enhancement in the arterial phase and swift expurgation in the portal phase”,13.4% (44/329) for as “swift enhancement and slow expurgation”,7.3% (24/329) as “swift enhancement and simultaneity expurgation”,4.3% (14/329) for the “slow enhancement and swift expurgation”,2.1% (7/329) as “slow enhancement and expurgation”,1.2% (4/329) as “not fast forward”.2.90.3% (297/329) of PHC lesions were hypervascular liver cancer and 9.7% (32/329) were hypovascular.Hepatocellular carcinoma (HCC) were hypervascular lesions and intrahepatic cholangiocarcinoma (ICC) were hypovascular lesions.3.PHC size had a significant difference on the contrast media purfusion pattern (P < 0.05),but not on the contrast media expurgation pattern.4.The accuracy of PHC by CEUS were 97.3% and compared to pathology,9 lesions of PHC were misdiagnosed.Conclusion:CEUS can show the different blood perfusion characteristics of PHC with closely related to pathological differentiation,which be valuable to diagnose liver cancer.