Eleven patients with hepatic cavernous hemangiomas who underwent hepatectomy in a last 12-year period were reviewed for imaging-based differential diagnosis and operative indications. The male-to-female ratio was 6:5, and the mean age was 49 years. The mean maximum diameter was 10cm. Most of the patients had giant hemangiomas. Two of them were found having a hemangioma at health screening examinations. Six including the two patients had no hemangioma-related symptoms at all. Angiography was performed on all patients, and atypical hypovascular findings were observed in two patients. MRI was useful for differential diagnosis. With the progress in diagnostic imagings, invasive angiography was considered not always necessary. A case of spontaneous rupture was experienced. In view of the fact that the mortality due to rupture of the hemangioma is high and safety of operation is increasingly assured, we believe that all hemangiomas, which are larger than 10cm in diameter, and locating close to, or protruding from the liver surface, should be possible candidates for hepatectomy.