Background and Aims: This study aimed to evaluate the diagnostic performance of high frame rate contrast-en-hanced ultrasound (H-CEUS) of focal liver lesions (FLLs). Methods: From July 2017 to June 2019, conventional con-trast-enhanced ultrasound (C-CEUS) and H-CEUS were per-formed in 78 patients with 78 nodules. The characteristics of C-CEUS and H-CEUS in malignant and benign groups and the differences between different lesion sizes (1–3 cm, 3–5 cm, or >5 cm) of C-CEUS and H-CEUS were examined. The diagnostic performance of C-CEUS and H-CEUS was ana-lyzed. The chi-square test or Fisher\'s exact test was used to assess inter-group differences. The receiver operating characteristic curve was plotted to determine the diagnostic performance of C-CEUS and H-CEUS. Results: There were significant differences in the enhancement area, fill-in direc-tion and vascular architecture between C-CEUS and H-CEUS for both benign and malignant lesions (all p=0.000–0.008), but there were no significant differences in washout results (p=0.566 and p=0.684, respectively). For lesions 1–3 cm in size, the enhancement area, fill-in direction, and vascular architecture on C-CEUS and H-CEUS were significantly dif-ferent (all p=0.000), unlike for lesions 3–5 cm or >5 cm in size. For differentiation of malignant from benign FLLs in the 1–3 cm group, H-CEUS showed sensitivity, specific-ity, accuracy, and positive and negative predictive values of 92.86％, 95.0％, 96.3％, 90.48％ and 93.75％, respectively, which were higher than those for C-CEUS (75.0％, 70.0％, 77.78％, 66.67％ and 72.91％, respectively). Conclusions: H-CEUS provided more vascular information which could help differentiate malignant from benign FLLs, especially for lesions 1–3 cm in size.