Abstract: Objective This study aimed to analyze the helical computed tomography (CT) features of patients with early hepatocellular carcinoma (HCC), so as to promote the diagnostic rate of early HCC. Methods Total of 115 cases of liver lesions less than 3 cm in diameter proved by pathological examination or clinical follow-up were screened, including 42 patients with hepatocellular carcinoma, 37 patients with metastatic liver cancer and 36 patients with hepatic hemangioma; and the characteristics of the enhanced multi-slice spiral CT scanning images were retrospectively analyzed. Results In this cohort, the difference in either gender or age among patients with hepatocellular carcinoma, metastatic liver cancer or hepatic hemangioma was not significantly (both P ＜ 0.05). In the arterial phase, majority of patients with hepatocellular carcinoma reveals high-density enhancement, and the proportion was significantly higher than that of patients with metastatic liver cancer (P ＜ 0.001); while in the venous and equilibrium phases, patients with hepatocellular carcinoma reveals low-density and no enhancement, and the proportion was also significantly higher than that of patients with metastatic liver cancer or hepatic hemangioma (P ＜ 0.001). Conclusions Multi-phase enhanced scanning using the 64-slice spiral CT is an effective method for diagnosing early hepatocellular carcinoma.