Sonazoid, a second-generation contrast agent, was approved for exclusive use in Japan in 2007. This agent has two extremely favorable features: (1) real-time vascular imaging ability, and (2) an extremely stable Kupffer phase in the postvascular phase for 10-60 minutes allowing multiple scanning. With these favorable features, differential diagnosis of hepatic tumors using Sonazoid-enhanced ultrasound (US) has been compared with Levovistenhanced US or multidetector computed tomography (MDCT). Furthermore, a new technique, ”defect reperfusion imaging” has made it possible to depict and diagnose nodules, which are not identified by B-mode US but are detected by MDCT. Thus, Sonazoid-enhanced US is a breakthrough technology in the diagnosis and treatment of hepatic tumors.