Microbubble contrast agents transform the ultrasound playing field in imaging of hepatocellular carcinoma (HCC). Recent literature suggests CEUS is accurate for diagnosis of HCC, differentiation of HCC and intrahepatic cholangiocarcinoma (ICC), problem solving of indeterminate MRI, and optimal characterization of nodules found on surveillance ultrasound. CEUS LI-RADS CORE has 3 essential criteria for non-invasive diagnosis of HCC within LR-5: size >1 cm, arterial phase hyperenhancement, and late weak washout. Validation studies show 96% specificity for HCC within LR-5, negating need for biopsy. Ultrasound is a high-resolution dynamic real-time modality overcoming challenges faced by CT/MR, including low resolution and fixed timing. Purely intravascular agents for CEUS show true washout in malignant lesions, as compared with MR/CT agents which can leak into the interstitium with enhancement in the late phase, especially of cholangiocarcinoma. LR-M tumors exemplify advantages of purely intravascular agents. “YES” we believe that CEUS is more than sufficient for non-invasive diagnosis of HCC.