This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose: This study retrospectively compared the accuracy of angiographic sentinel signs (sentinel vessels, hypovascular areas, and delayed dots) with extravasation in the diagnosis of ruptured

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... epatocellular carcinoma (HCC). Materials and Methods: Sixteen patients diagnosed with HCC between March 2007 and November 2011 were evaluated. Among the patients, we identified 32 HCCs (19 ruptured, 13 unruptured), and assessed all HCCs by hepatic angiography with regard to extravasation, sentinel vessels, hypovascular areas, and delayed dots. We compared the sensitivity and specificity of the sentinel signs with those of the extravasation for the diagnosis of a ruptured HCC. Results: For the angiographic diagnosis of a ruptured HCC, the sensitivity of the sentinel signs (sentinel vessel, 63.2%; hypovascular area, 89.5%; delayed dot, 72.7%) was higher than the sensitivity of extravasation (15.8%). The difference in sensitivity between each sentinel sign and extravasation was statistically significant (sentinel vessel, p = 0.012; hypovascular area, p < 0.001; delayed dot, p = 0.039). The specificity of sentinel signs for the diagnosis of ruptured HCC was not statistically different from the specificity of extravasation. Conclusion: Sentinel signs are more accurate than extravasation for the angiographic diagnosis of a ruptured HCC.