Digital subtraction imaging was compared to helical CT, DSA, and US angiography to assess its usefulness in the evaluation of vascularity in hepatocellular carcinoma (HCC). Digital subtraction imaging using Levovist as the contrast agent was performed in 41 patients with 43 nodules (22 men and 19 women, aged 50 to 83 years; mean age, 65 years; mean maximum tumor diameter, 27.8+/-17.1 mm). Digital subtraction imaging showed hypervascular enhancement in 39 of the 43 nodules (91%). Helical CT showed areas of high attenuation in 40 of the 43 nodules (93%), while DSA and US angiography showed positive enhancement in 38 and 43 of the 43 nodules (88% and 100%), respectively. Digital subtraction imaging is useful for evaluating vascularity in HCC when the tumor can be visualized with non-enhanced US angiography.