Objective: To explore the role of transrectal contrast-enhanced ultrasound and color Doppler ultrasound in the differential diagnosis of rectal cancer and rectal stromal tumor. Methods: A retrospective analysis was made of the medical records of 82 patients with rectal cancer who were treated in our hospital from January 2017 to January 2020. According to the results of postoperative histopathological examination, they were divided into two groups: the rectal cancer group (53 cases) and the rectal stromal tumor group (29 cases). The maximum diameter, peak blood flow velocity, resistance index, ultrasonographic characteristics, IMAX, RT, TTP and MTT of the two groups were compared, and the coincidence rate of differential diagnosis between rectal cancer and rectal stromal tumor was also compared. Results: The mean maximum diameter, peak flow velocity and resistance index of rectal cancer group were significantly higher than those of rectal stromal tumor group (P < 0.05). In CDUS features, the internal echo of rectal cancer was more uniform than that of rectal stromal tumor, and most of the lesions surrounded the intestinal cavity, the difference was statistically significant (P < 0.05). The IMAX value of CEUS in rectal cancer group was higher than that in rectal stromal tumor group, and the RT value, TTP value and MTT value of CEUS were significantly lower than those in rectal stromal tumor group (P < 0.05). The accuracy rate of CEUS was 98.11% (52 / 53), 93.101% (27 / 29), 96.34% (79 / 82), 86.79% (46 / 53), 89.66% (26 / 29) and 87.80% (72 / 82), respectively The total coincidence rate of different diagnosis of rectal cancer and rectal stromal tumor was significantly higher than that of CDUS (P < 0.05). Conclusion:Transrectal CEUS and CDUS play a higher role in the differential diagnosis of rectal cancer and rectal stromal tumor, and transrectal CEUS has a higher value than CDUS, which is worth popularizing.