AIM To compare and analyze the contrast enhancement appearance of small hemangioma (SHHE) and small hepatocellular carcinoma (SHCC) with helical multi-phase CT scanning so as to determine their roles and pitfalls in the differential diagnosis of SHHE and SHCC.METHODS The pre and postcontrast CT scanning of the liver in 73 cases (38 SHHE, 35 SHCC) were carried out. The first phase scan of the entire liver began at 30s after the injection of contrast medium, the second and third phases began at 70s, and 4min respectively. The contrast enhancement patterns and characteristics of all lesions were observed and compared.RESULTS In SHHE, 64.29% (27/42) had typical manifestations in two-phase dynamic scanning, such as peripheral dramatic high-density enhancement of the lesions with progressive opacification from the periphery toward the center, 30.95% (13/42) were hyperdense in both phases and 4.76% (2/42) were hypodense in both phases. In the third phase scanning, 96.67% (28/30) of SHHE were hyperdense and isodense. In SHCC 59.52% (25/42) presented typical appearances, such as hyperdense in the first phase and hypodense in the second phase, 23.81% (10/42) were hyperdense in the first phase and isodense in the second phase with 4.76% (2/42) of hypodense in both phases. In the third phase scanning, 85.71% (24/28) of SHCC were hypodense.CONCLUSION According to the contrast enhancement patterns of SHHE and SHCC in the two-phase or multi-phase scanning by helical CT, diagnosis can be established in the majority of lesions, while some atypical cases needed MRI for further investigation.