ObjectiveTo elucidate the evaluation of vascular heterogeneity in papillary thyroid cancer (PTC) by contrast-enhanced ultrasound (CEUS) and its relationship with key prognostic indicators of PTC, aiming to provide theoretical support for precise preoperative assessment and individualized treatment of PTC. MethodThe recent advances in domestic and international research on the application of CEUS for evaluating vascular heterogeneity in PTC and its association with prognosis were reviewed. ResultsCEUS can effectively assess the vascular heterogeneity of PTC through microbubble contrast technology. Among the features, hypervascular characteristics (hyper- or iso-enhancement) are independently associated with gross extrathyroidal extension, clinically node-positive status, and structural recurrence, while hypovascular characteristics (hypo-enhancement) suggest a lower risk of invasiveness. Studies on molecular mechanisms indicate that the core drivers of vascular heterogeneity in PTC are the differential activation of metabolic pathways (such as oxidative phosphorylation and Hippo signaling pathway), rather than classical angiogenesis pathways (e.g., vascular endothelial growth factor). Furthermore, long noncoding RNAs may indirectly participate in this process by regulating metabolism-related genes. ConclusionsAs a non-invasive preoperative imaging tool, CEUS can effectively evaluate the vascular heterogeneity of PTC and hold marked potential in predicting PTC prognosis. In the future, through multicenter validation, technical optimization, and further mechanistic research, CEUS has the potential to be integrated into the precision diagnosis and treatment system for PTC, providing a critical basis for prognosis risk stratification and individualized interventions based on vascular characteristics.