Abstract: Objective Evaluate the accuracy of contrast-enhanced ultrasound diagnostic reports for pancreatic lesions. Methods In this retrospective study, patients who underwent contrast-enhanced ultrasound examination of pancreatic lesions at Peking Union Medical College Hospital from January 2017 to December 2022 and received a confirmed pathological diagnosis were included. Using pathological diagnosis as the gold standard, the study evaluate the accuracy of contrast-enhanced diagnostic ultrasound. It also analyzed the misdiagnosis of contrast-enhanced ultrasound in diagnosing various pathological types of pancreatic lesions. Results Of the 859 patients met inclusion and exclusion criteria, 489 were male (56.9%) and 370 were female (43.1%). The ages ranged from 16 to 85 years, with a median age of 60 (53,66) years. With the exception of 47 pancreatic space-occupying lesions that pose challenges in being categorized as either benign or malignant, a total of 812 cases were included in the study on the diagnostic efficacy analysis of benign and malignant lesions.The diagnostic sensitivity and specificity of contrastenhanced ultrasound for pancreatic malignant lesions were 98.3%（95%CI： 97.1%~99.1%） and 79.0%（95%CI ： 70.1%~86.4%）, AUC was 0.887（95%CI ： 0.863~0.908）, positive and negative predictive value were 96.9% （ 95%CI ： 95.6%~97.9% ） and 87.4% （ 95%CI ： 79.6%~92.4%）, positive and negative likelihood ratio were 4.69（95%CI ： 3.24~6.80） and 0.02（95%CI ： 0.01~0.04）. The diagnostic accuracy rate of contrast-enhanced ultrasound for diagnosing benign and malignant pancreatic lesions was 95.8%. Out of the 859 lesions examined, 48 cases were misdiagnosed by contrast-enhanced ultrasound, with a misdiagnosis rate of 5.6% (48/859), including 7 cases (0.8%) of undetermined diagnosis, while the diagnostic accuracy of pancreatic ductal adenocarcinoma was as high as 98.8%. No complications occurred in any of the patients. Conclusions Contrast-enhanced ultrasound is a safe and effective imaging method for evaluating microvascular perfusion in various pancreatic lesions. It has significant clinical value in diagnosing both benign and malignant pancreatic lesions, particularly in diagnosing pancreatic ductal adenocarcinoma.