Objective To compare the diagnostic value of gray-scale ultrasound and contrast-enhanced ultrasound radiomic features in patients with focal liver lesions (FLLs). Methods The clinical data of 162 patients with FLLs who underwent gray-scale ultrasound or contrast-enhanced ultrasound examinations in the hospital from February 2017 to November 2021 were retrospectively analyzed. The diagnostic value of the two methods for FLLs was compared. Results Contrast-enhanced ultrasound found that the intensity of malignant lesions in hepatic arterial phase was higher than that of surrounding tissues

and the enhancement in portal venous phase was stronger than that of surrounding liver tissues

with a clear boundary between the two. Contrast-enhanced ultrasound found that compared with surrounding liver tissues

benign lesions showed iso-enhancement or slightly high enhancement in hepatic arterial phase

and contrast agent moved slowly from the periphery to the center of lesion. The benign lesions showed iso-enhancement or high enhancement in portal venous phase and delayed phase

without obvious regression of contrast agent. 1 histogram characteristic

1 texture characteristic and 3 wavelet characteristics were taken as the predictive factors the 274 radiomic features. The area under the curve (AUC)

sensitivity and specificity of training cohort and validation cohort the 274 radiomic features to predict malignant lesions were 0.872

83.33%

80.00% and 0.812

76.67%

79.24%

without statistically significant difference (P>0.05). The AUC

sensitivity and specificity of radiomic model were significantly higher than those of contrast-enhanced ultrasound (P<0.05). Conclusion The gray-scale ultrasound radiomic features are effective in the diagnosis of benign and malignant FLLs

and can achieve better performance than contrast-enhanced ultrasound

which provides an objective basis for clinical diagnosis.