Hepatocellular carcinoma (HCC), constituting 75-85% of primary liver cancer cases, ranks as the third leading cause of global cancer-related mortality. The early diagnosis of HCC is critical for determining optimal clinical therapeutic strategies. Radiofrequency ablation (RFA) has emerged as a preferred for managing early-stage HCC cases, primarily due to its less invasive nature, simplicity and safety. Advanced imaging for pre-operative evaluation of HCC has been increasingly used. Contrast-enhanced ultrasound (CEUS) has improved the clinical application of ultrasound (US) in HCC. It also provide more accurate informations for guiding RFA procedures. In the future, CEUS, through its convergence with emerging artificial intelligence (AI)-driven technologies, will play an even greater role in HCC management. This systematic review evaluates the utility of Sonazoid-enhanced contrast ultrasound (Sonazoid-CEUS), particularly its unique Kupffer phase imaging, in improving HCC diagnostic and optimizing RFA precision via real-time monitoring capabilities and prolonged imaging windows (up to 60 minutes).