We reviewed recent advances in the imaging of hepatocellular carcinoma (HCC), with particular emphasis on the early detection of small nodular HCC. In high-risk patients, periodic ultrasound screening with tumor marker (α-fetoprotein and PIVKA-11) measurement is the most useful method to detect small HCC. Computed tomography (CT) is the second choice, and an incremental dynamic technique using spiral CT is useful in the detection and differentiation. Magnetic resonance (MR) imaging is used to differentiate HCC from cavernous hemangioma and some tumor-like conditions including adenomatous hyperplasia. In selected patients, CT during arterial portography and superparamagnetic iron oxide-enhanced MR imaging are diagnostic. Characteristic findings of HCC are a peritumoral fibrous capsule, an intratumoral mosaic appearance and hypervascularity; however, these findings are not frequently seen in HCC < 2 cm. Imaging characteristics of some variants of HCC and the differentiation of HCC from other hepatic tumors and tumorlike conditions are also discussed