Aim: This study aimed to clarify the ultrasound semiotics of colorectal cancer liver metastases contrast enhancement, and perform a comparative assessment of the diagnostic efficacy of contrast-enhanced ultrasound and computed tomography (CT).Methods: We studied 40 patients with colorectal cancer: patients receiving treatment for the disease and having newly diagnosed colorectal cancer. All patients underwent contrast-enhanced ultrasound and CT. In the cases of suspected malignancy, a trephine biopsy and a morphological examination were performed.Results: Contrast-enhanced ultrasound and CT demonstrated comparable and high diagnostic efficacy. The sensitivity of the contrast-enhanced ultrasound in malignancy detection was 93.3%, with 90% specificity, 96.55% positive predictive value, 81.82% negative predictive value, and 92.5% accuracy. The sensitivity of contrast-enhanced CT was 93.3%, with 80% specificity, 93.33% positive predictive value, 80% negative predictive value, and 92.5% accuracy.Conclusions: For patients with colorectal cancer with contraindications to contrast-enhanced CT, contrast-enhanced ultrasound may be used an alternative imaging option for the differential diagnosis of liver neoplasms.