Objective: To explore the application of ultrasound in the differential diagnosis and treatment of metastatic neuroendocrine tumors of the liver (NETLM). Methods: A retrospective analysis of 30 patients with non-neuroendocrine metastatic liver cancer (NNETLM) and 29 patients with NETLM were admitted between April 2018 and March 2021, and were diagnosed with ultrasound. ROC curve was used to analyze the predictive value of ultrasound quantitative indicators At the same time, ultrasound-guided ablation treatment was performed on patients with NNETLM to analyze the treatment effect. Results: The peak time (23.52 ± 4.44) s, decline time (44.55 ± 9.41) s and peak intensity (19.79 ± 3.45) dB in netlm group were higher than those in nnetlm group (P < 0.05). According to ROC curve analysis, AUC of netlm predicted by start enhancement time is 0.549, 95% interval is 0.400-0.699, AUC of netlm predicted by peak time is 0.657, 95% interval is 0.517-0.798, AUC of netlm predicted by decline time is 0.809, 95% interval is 0.700-0.918, AUC of netlm predicted by peak intensity is 0.777, 95% interval is 0.656-0.898, AUC of netlm predicted by four items is 0.945, 95% interval is 0.890-1.000. All 29 patients successfully completed the treatment, and 26 lesions were completely inactivated by only one ablation. Conclusion: Ultrasound can accurately identify NETLM, and complete the relevant treatment under the guidance of ultrasound, which can improve the success rate of one-time ablation, and has a high identification value.