ABSTRACT Objective To analyze the enhancement pattern and characteristic features of hepatic focal nodular hyperplasia (FNH) in contrast-enhanced ultrasound, and to evaluate the qualitative diagnosis value of contrast-enhanced ultrasound for FNH. Methods Data of patients with FNH confirmed by pathology and preoperative contrast-enhanced ultrasound were collected. Their clinical data, conventional ultrasound images and contrast-enhanced ultrasound images were retrospectively analyzed. Results A total of 112 cases with FNH were enrolled, the majority of which were aged from 18 to 50 years, and the ratio of male to female was 1.11:1. The conventional ultrasound was mainly characterized by low echoes, and radiant blood flow signal was visualized in 31 cases (31/112, 27.68%). The enhancement patterns of the contrast-enhanced ultrasound three phases (arterial, portal venous, and delayed phase) mainly presented as hyper-hyper-hyper-enhancement (49/112, 43.75%) and hyper-iso-iso enhancement (44/112, 39.29%). The characteristic features included centrifugal enhancement (62/112, 55.36%), wheel-shaped radiant artery (59/112, 52.68%), and central stellate scar (52/112, 46.43%). Among them, the wheel-shaped artery and central stellate scar was commonly observed in the large lesion size group (≥ 3 cm) (P<0.01), while the centrifugal enhancement was more common in the small lesion size group (< 3 cm). The diagnosis coincidence rate of conventional ultrasound was 32.14%, and the rate of contrast-enhanced ultrasonography was 89.28%. Conclusions The contrast-enhanced ultrasonography can significantly improve the noninvasive diagnostic accuracy of FNH.