Objective: To research the diagnostic value of contrast-enhanced ultrasound for hepatocellular carcinoma (diameter ≤3cm) in patients with chronic liver disease. Methods: Imaging and clinical data of 252 focal liver lesions in patients with chronic liver disease who underwent CEUS examination in our hospital were retrospectively analyzed to evaluating the diagnostic value of CEUS for HCCs ≤3cm. Results: The typical enhancement patterns of hyper – iso – hypo and hyper - hypo – hypo were revealed in 37/95(38.95%) and 28/95(29.47%),and the atypical enhancement patterns were revealed in 27/95(28.42%) in HCCs ≤3cm . HCCs＞2cm displayed a higher proportion of typical enhancement pattern and a lower proportion of atypical enhancement pattern compared with that of HCCs ≤ 2cm (both P < 0.05). The accuracies were 84.52% and 93.65%, the sensitivities were 65.26% and 93.68%, and the AUCs were 0.807 and 0.937,respectively (all P < 0.05), when typical CEUS enhancement pattern was considered to be diagnostic criteria for HCCs and atypical enhancement combing with the high risk of hepatocellular carcinoma was also assuming to be indicative of HCCs. Conclusions: Atypical contrast-enhanced ultrasound features may appear in HCCs ≤3cm , and the smaller the lesion, the higher the proportion. The diagnostic efficacy of CEUS for HCCs ≤3cm can be improved by combining the high-risk of hepatocellular carcinoma , typical and atypical enhancement patterns.