By comparing the diagnostic accuracy of spectral CT and conventional CT in evaluating treatment response efficacy after TACE, this study aims to investigate the diagnostic performance of spectral CT in assessing treatment response following TACE for hepatocellular carcinoma.

Inclusion Criteria:

1. age 18-75 years;
2. diagnosis of HCC based on pathological findings or accepted clinical and imaging criteria;
3. Barcelona Clinic Liver Cancer (BCLC) stage A or B;
4. prior treatment with TACE;
5. undergoing contrast-enhanced spectral CT at 4-8 weeks after TACE;
6. undergoing either liver resection within 1 week after contrast-enhanced spectral CT (surgical cohort) or undergoing hepatic digital subtraction angiography (DSA) or contrast-enhanced MRI within 1 week after contrast-enhanced spectral CT (non-surgical cohort);
7. informed consent.

Exclusion Criteria:

1. contraindications to contrast-enhanced CT or MRI;
2. presence of extrahepatic malignancy;
3. poor image quality or incomplete clinical data;
4. lack of regular CT or MRI follow-up in non-surgical cohort;
5. withdrawal from the study.

Patients recruited from six comprehensive medical centers nationwide