Objective To explore the CT findings and their diagnostic value of pathological grading in patients with hepatocellular carcinoma. Methods A total of 500 cases of patients who diagnosed as hepatocellular carcinoma and treated with partial hepatectomy in our hospital from September 2016 to September 2017 were selected, and they were given CT enhanced scan before operation. The blood supply types of CT scan and the CT signs of tumor size, portal vein or hepatic vein tumor thrombus, necrosis in the tumor, liver cirrhosis and lymphadenopathy were observed. The CT findings were compared with postoperative pathological results, and the relationship between CT findings and pathological grading was analyzed. Results Among 500 patients with hepatocellular carcinoma in this study, 317 cases (63.40%) were hepatic artery type, 126 cases (25.20%) were dual blood supply type of hepatic artery and portal vein, and 57 cases (11.40%) were less blood supply type and 0 case was portal vein blood supply. There were no statistically significant differences in tumor size, portal vein or hepatic vein tumor embolus of CT scan compared with those of surgical pathology results (P>0.05). There were statistical significant differences in the necrosis in the tumor, liver cirrhosis and lymphadenopathy of CT scan compared with those of surgical pathology results (P<0.05). There were 70 cases (62.50%) in pathological grades I and II and 42 cases (37.50%) in grades III and IV. CT showed that the larger cancer cells, the clearer edges, hemorrhage and necrosis in the tumor, and invasion and metastasis all resulted in a higher tumor grade (P<0.05). Conclusion CT findings of patients with hepatocellular carcinoma can provide an objective reference for pathological grading, and it has a certain diagnostic value.