Objective To investigate the value of contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system version 2017 (LI-RADS v2017) in the differential diagnosis between hepatocellular carcinoma (HCC) and other hepatic malignancies (OM) less than or equal to 3 cm. Methods The clinical and imaging data of 163 liver lesions less than or equal to 3 cm in 126 patients with pathologically-confirmed liver malignancy were retrospectively analyzed. The patient underwent CEUS from Jan. 2018 to Jun. 2022 in our hospital, including 133 with HCC and 30 with OM. Nodules were classified based on the CEUS features according to the CEUS LI-RADS v2017. The evaluation of CEUS characteristics and CEUS LI-RADS v2017 in differential diagnosis of HCC and OM were calculated based on pathological findings. Results There were significant differences in the characteristics of arterial phase enhancement, timing of washout onset and washout degree between the HCC group and the OM group (all P＜0.001). The HCC group was mainly LR-3 (20 lesions, 15.04%), LR-4 (25 lesions, 18.80%) and LR-5 (82 lesions, 61.65%), and the OM group was mainly LR-M (28 lesions, 93.33%). The specificity and positive predictive value of late washout for HCC were 93.33% (28/30) and 98.06% (101/103), respectively; and the sensitivity of early washout for OM was 93.33% (28/30). With LR-5 as the criterion to diagnose HCC, the sensitivity was 61.65% (82/133), the specificity was 93.33% (28/30), and the positive predictive value was 97.62% (82/84); with LR-4/5 as the criterion to diagnose HCC, the sensitivity was 80.45% (107/133), the specificity was 93.33% (28/30), and the positive predictive value was 98.17% (107/109), with the sensitivity of LR-4/5 being significantly higher than those of LR-5 (P＝0.001). With LR-M as the criterion to diagnose OM, the sensitivity was 93.33% (28/30) and the specificity was 95.49% (127/133). Conclusion The CEUS LI-RADS v2017 can effectively distinguish HCC from OM less than or equal to 3 cm. LR-5 has a low sensitivity for HCC, while LR-4/5 can improve the sensitivity for HCC.