We studied ultrasonographic changes in 13 cases (14 nodules) of hepatocellular carcinoma treated by ethanol injection (EI). We performed plain ultrasonography (PU) and enhanced ultrasonography (EU) before and after EI on each nodule. All the nodules revealed hyperechoic change by EU before EL EU findings after EI were classified into three patterns; Pattern 1: Total hypoechoic change. (3 nodules) Pattern 2: Hypoechoic change with capsular hyperechoic change. (3 nodules) Pattern 3: Hypoechoic change with capsular and subcapsular hyperechoic change. (8 nodules) In a patient who showed pattern 3, during the enhancement of the tumor by microbubbles we added percutaneous ethanol injection (PEI), because the enhanced lesions were still considered viable. EU thus makes it possible to recognize residual cancers to be treated.