Objective To determine the value of contrastenhanced ultrasound (CEUS) in the differentiation of hepatic hemangioma (HHE) and hepatic alveolar echinococcosis (HAE). Methods The data of 102 patients with HHE or HAE were collected between January 2010 and April 2019. Grayscale and CEUS features of the patients were analyzed. The frequency of each imaging finding, including location, number, size, internal echo, boundary, morphology, blood flow, arterial enhancement, and internal enhancement were evaluated and compared.Results There was no significant difference in age and gender composition between the two groups (P＞0.05). 61 HHE lesions were detected in 57 patients. The diameters of HHE lesions were 0720cm with an average of (6.5±3.9) cm. 57 HAE lesions were found in 45 patients. The diameters of HAE lesions were 1320 cm with an average of (8.7±4.9) cm. The difference in lesion size between the two groups was statistically significant (P＜0.05). There were no statistically significant differences in lesion internal echo composition, and the blood flow between the two groups (P＞0.05). There were statistically significant differences in lesion location, boundary and morphology between the two groups (P＜0.05). Contrastenhanced ultrasonography had a higher detection rate than conventional ultrasonography for hepatic echinococcosis and hepatic hemangioma, and the difference was statistically significant (P＜0.05). The presence of arterial enhancement and absence of internal enhancement were significantly different between HHE and HAE (P＜0.05). Conclusion The ultrasonographic findings of HHE and HAE were partly similar, but there were significant differences in contrastenhanced ultrasonography. HAE and HHE detection rates have been improved with CEUS, and they can be distinguished with Grayscale and CEUS.