Abstract:Non-surgical modalities was widely used in the treatment of middle and advanced hepatocellular carcinoma (HCC). Thus, how to enact a personalized treatment plan or adjust the plan in time according to the efficacy is a key issue that needs to be urgently solved in the clinic nowadays, so it is especially important to accurately assess the efficacy of the treatment of middle and advanced HCC at an early stage. At present, enhanced computed tomography (CT) and enhanced magnetic resonance imaging (MRI) are the main assessment modalities. , However, CT is radioactive and not suitable for repeated examinations while theMRI is expensive and limited for patients. Contrast-enhanced ultrasound (CEUS) has been considered a better way to detect the tumors with high sensitivity and dynamic and without radiation. We summarized the current research advances of ultrasonography in the evaluation of the efficacy of non-surgical treatment of middle and advanced HCC.