Objective To analyze the sensitivity of high-speed multi-slice spiral CT in diagnosis of satellite nodules ≤ 2cm of hepatocellular carcinoma (HCC). Methods A total of 64 patients with HCC satellite nodules confirmed by histopathological examination in our hospital from April 2013 - October 2016 were examined by high-speed multi-slice spiral CT three-phase contrast enhanced scanning. The results were compared with those of digital subtraction angiography (DSA) within 5 days after CT scanning. The sensitivity and imaging features of high-speed multi-slice spiral CT in diagnosis of HCC satellite nodules ≤ 2cm were analyzed. Results There were 64 primary lesions, 216 satellite nodules (49 satellite nodules in left lobe, 167 satellite nodules in right lobe), 181 satellite nodules (83.79%) ≤ 2cm and 48 satellite nodules <1cm detected by high-speed multislice spiral CT. There were 64 primary lesions, 161 satellite nodules (42 satellite nodules in left lobe, 119 satellite nodules in right lobe), 119 satellite nodules (83.79%) ≤ 2cm and none nodules <1cm detected by DSA. There were significant differences in the size distribution and the average number of satellite nodules between CT and DSA (P<0.05). CT plain scan showed 184 low-density HCC satellite nodules and 22 equal-density HCC satellite nodules. Contrast-enhanced scan showed 184 mild or obviously enhanced HCC satellite nodules in arterial phase, 211 low-density satellite nodules in balance phase, 5 equal-density satellite nodules. There were 173 typical HCC satellite nodules. Threephase contrast-enhanced scan showed 37 satellite nodules without enhancement. The enhancement rate of satellite nodules ≤ 2cm was 76.24%. DSA staining of 161 HCC satellite nodules was obvious, and the blood supply was good. Conclusion High-speed multi-slice spiral CT has obvious advantages over DSA in the diagnosis of HCC satellite nodules, especially suitable for diagnosis and detection of smaller tumors (<1cm).