Hepatocellular carcinoma (HCC) is one of the common malignancies, for which, surgical resection and liver transplantation may be potentially curative remedies but the prognosis remains poor due to a high likelihood of postoperative recurrence. Microvascular invasion (MVI) is an independent prognostic factor, and its preoperative diagnosis has become a hot topic in the field of research. Here, the authors review the current research progress in preoperative prediction of HCC with MVI.