We investigated the clinical utility of a new grading system for malignant hepatocellular carcinoma (HCC) using a combination of two different contrast-enhanced ultrasonographic (CEUS) images. 33 patients with histologically confirmed 42 HCC nodules (well-differentiated, n=15; moderately-differentiated, n=23; poorly-differentiated, n=4) received CEUS. Kupffer phase and Maximum Intensity Projection (MIP) images were classified respectively by their patterns as follows: Kupffer images (i) hyper; (ii) iso; (iii) hypo; MIP findings (i) Fine; (ii) Vascular; (iii) Irregular. Based on the combination of these two images, they were classified into five grades. The correlation between this new and the histological grading showed that this new grading system could predict moderate- and poorly-differentiated HCC; iso-Fine 0%, iso-Vascular 50%, hypo-Fine 57%, hypo-Vascular 82%, Irregular 100%.