Abstract: The prevention and treatment of hepatocellular carcinoma (HCC) is a major public health problem worldwide. At present, surgery is the main treatment method for HCC, while recurrence and metastasis are the main obstacles to the improvement of the survival rate of HCC patients. Microvascular invasion (MVI) is the embolus of cancer cells with micro-metastasis in liver vessels, which is closely associated with the postoperative recurrence, metastasis, and poor prognosis of HCC. At present, MVI can only be confirmed through postoperative pathological examination, while the preoperative prediction of MVI is helpful for the accurate treatment of HCC patients and helps further improve the survival rate of patients and select the best liver transplantation recipients. This review emphasizes the importance of the preoperative prediction of MVI for accurate treatment of HCC patients, summarizes the latest advances in the prediction of MVI by imaging features, routine serum protein markers, and novel molecular markers, highlights the MVI prediction ability of the multi-index prediction model, and evaluates the great potential of liquid biopsy in predicting MVI.