Objective: To evaluate the value of vascular index measured by smart 3D superb microvascular imaging in the differential diagnosis of parotid pleomorphic adenoma (PA) from Warthin""s tumor (WT). Methods: Eighty-eight cases of parotid masses (51cases of PA and 37 cases of WT) were examined by gray scale ultrasound, Color Doppler flow imaging(CDFI), two-dimensional SMI, smart 3D superb microvascular imaging and contrast enhanced ultrasonography (CEUS). The differences in gray-scale ultrasound features (size, shape, boundary, echo, and liquefaction), CDFI (blood flow grade and vascular distribution), 2D SMI (blood flow grade and vascular distribution), and smart 3D SMI (vascular index (VI)) between PA and WT were evaluated. The diagnostic effectiveness of different tests in differentiating PA and WT was evaluated by receiver working curve (ROC) and its area under the curve. Results: There were no significant differences between PA and WT in shape, echo and coarse calcification (P > 0.05), but there were significant differences in vascular distribution type and blood flow classification (P < 0.001). time intensity curve (TIC) analysis showed that: Compared with the PA group, the peak intensity (PI), half time to descent (DT/2), 120s intensity and area under the cure in WT group AUC, semi-descent slope (DS/2), the difference was statistically significant (P < 0.05). Contrast agent arrive time (AT), baseline intensity (BI), time to peak (TTP), descending slope, There was no statistical significance in DS (P > 0.05). ROC curve analysis showed that PI > 36.16dB, DT/2 > 65.42, 120s intensity > 11.91dB, AUC > 2493.55, DS/2 > 0.42 were the best critical values for the diagnosis of WT. If VI is > 17.73, it indicates that WT is more likely. The diagnostic accuracy of VI measured by intelligent 3D SMI for pathological types of parotid tumors was higher than that of 2D SMI and CDFI (P < 0.05), and there was no significant difference with CEUS (P > 0.05). Conclusions: Intelligent 3D SMI technology can be used as a non-invasive tool for the differential diagnosis of parotid PA and WT, and is expected to be widely used.