Abstract: Objective: To analyze the clinical application value of multi-slice spiral CT angiography (MSCTA) in the evaluation of hepatic artery portal venous fistula (HAPVF) and extrahepatic blood supply artery in patients with primary liver cancer (PLC). Method: Retrospectively analyzed the clinical data of 86 patients with PLC admitted to our invasive technology department from September 2015 to April 2017. According to the maximum tumor diameter of MSCTA image, the subjects were divided into three groups:A, B and C, of which 22 cases were A (the maximum diameter of tumor was not more than 5 cm), and 28 cases in group B (the maximum diameter of tumor was between 5~10 cm), and 36 cases in group C (the maximum diameter of tumor was more than 10 cm). Compared and analyzed MSCTA and digital subtraction angiography (DSA) to evaluate the incidence of HAPVF and the blood supply of extrahepatic ectopic arteries. With the results of DSA as "gold standard", MSCTA was used to assess the incidence of HAPVF and the accuracy of the blood supply of extrahepatic ectopic arterial and to analyze the risk factors associated with the occurrence of HAPVF. Results: In 86 cases of PLC, 44 cases of HAPVF were detected by DSA, the incidence rate was 51.2% (44/86), 24 cases were central type (54.5%), and 20 cases were peripheral type (45.5%). However, with the DSA result as "gold standard", 42 cases were detected by MACTA. The total accuracy rate was 95.5% (42/44), the central type was 24 cases, the detection accuracy was 100% (24/24), and the peripheral type was 18 cases, the detection accuracy was 90% (18/20). Therefore, the results of MACTA detection were not significantly different from that of DSA (<i<χ</i<<sup<2</sup<=3.097, <i<P</i<=0.078<0.05). Logistic regression analysis showed that the number of tumors, the maximum diameter of tumor exceeded 5 cm and cirrhosis were the risk factors of HAPVF formation. The DSA examination showed that 70 cases of hepatic artery blood supply and 11 cases of extrahepatic blood supply were found. All the sources of extrahepatic blood supply were in group B and C, and the incidence was 14.3% (4/28) and 19.4% (7/36) respectively, including 9 cases (81.8%) and 2 central type (18.2%). With DSA results as "gold standard", 10 cases of extrahepatic blood supply were detected by MACTA, the detection accuracy was 90.9% (10/11). There was no significant difference in the detection results of MACTA and that of DSA (<i<χ</i<<sup<2</sup<=1.048, <i<P</i<=0.306<0.05). Conclusion: MACTA can carefully evaluate the source of blood supply and HAPVF in the tumor, and understand the anatomy and variation of the hepatic artery, portal vein and liver tumor. So it can provide the objective basis for the interventional treatment of PLC patients.