Abstract: Objective:To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) in the diagnosis of liver cirrhosis with small hepatocellular carcinoma (SHCC) and its correlation with clinical pathological features and microvascular formation.Methods:80 patients with liver cirrhosis and SHCC in our hospital were selected as the study group, and another 80 patients with hepatic dysplastic nodule(DN)in liver cirrhosis during the same period were selected as the control group.The CEUS parameters time to peak (TTP), peak intensity (PI), enhancement time (ET), enhancement slope (ES), and microvascular density (MVD) of the two groups were compared.Spearman/Pearson correlation coefficient model was used to analyze the correlation between CEUS parameters and pathological features and MVD of patients with liver cirrhosis and SHCC, and the decision DCA curve was drawn to analyze the clinical efficacy of CEUS parameters in the diagnosis of liver cirrhosis with SHCC.Results:The TTP and ET in the study group were lower than those in the control group, while PI, ES, and MVD were higher than those in the control group (P< 0.05); the study group showed higher levels of TTP and ET in highly differentiated patients compared to moderately differentiated patients, higher levels of PI and ES in moderately differentiated patients compared to poorly differentiated patients, lower levels of PI and ES in highly differentiated patients compared to moderately differentiated patients, and lower levels of PI and ES in moderately differentiated patients compared to poorly differentiated patients (P< 0.05); TTP and ET were positively correlated with the degree of differentiation of liver cirrhosis with SHCC, negatively correlated with MVD, and PI and ES were negatively correlated with the degree of differentiation, positively correlated with MVD (P< 0.05); the area under the curve (AUC) of TTP, PI, ET, and ES for diagnosing the liver cirrhosis with SHCC alone were 0.757, 0.715, 0.755, and 0.783, respectively, and the maximum AUC for combined diagnosis was 0.920; TTP ≤29.50 s, PI ≥25.74 dB, ET ≤21.25 s and ES ≥1.96 all significantly increased the risk of liver cirrhosis with SHCC(P< 0.05); the combination of TTP, PI, ET, and ES had good diagnostic efficacy for the liver cirrhosis with SHCC.Conclusion:The CEUS parameters TTP, PI, ET and ES are closely related to the degree of differentiation and microvascular formation of liver cirrhosis with SHCC, and have high reference value in the clinical diagnosis and treatment of liver cirrhosis with SHCC.