The patient was a 62-year-old man. The anamnesis revealed an alcoholic liver disease. The patient was admitted to the department of otolaryngology in our hospital with sudden deafness in March 2003. The liver damage was pointed out due to the laboratory data on admission. A liver tumor was identified on the subsequently performed CT scan and the patient was referred to another department at another ward for detailed examinations. Based on the results of contrast echography, CT findings and angiography a HCC was diagnosed and RFA was performed. The conventional B-mode ultrasound examination sometimes presented unclear cross-sectional images of the tumor at the target area, and so additional treatment had to be given from time to time. Simultaneously with the puncturing multi-slice imaging could be obtained, allowing exact and definite performance of the RFA using a 4D real-time ultrasound system. Additionally, ultrasound examination with contrast media was conducted to help determine the efficacy of treatment.