Abstract: Objective To investigate the feasibility, efficacy, and safety of percutaneous ultrasound-guided radiofrequency ablation(RFA) with artificial ascites for hepatocellular carcinoma(HCC) in the hepatic dome. Methods We retrospectively analyzed the clinical data of 22 patients with HCC in the hepatic dome with 25 lesions underwent percutaneous ultrasound-guided RFA with artificial ascites from January 2010 to December 2012. We used Seldinger technique to artificially induce ascites before RFA to improve tumor visibility or electrode path and to separate the RFA zone from the diaphragm. We assessed the technical feasibility, safety and efficacy of this technique in clinic. Results RFA was successfully performed in 88.0% (22/25) lesions after artificial ascites was achieved. There was substantial improvement in the visibility of partially visible tumors and in achieving a better path of the tumors with a poor electrode path. All patients showed complete absorption of artificial ascites after 3-day follow-up ultrasound. There was no patient showed any serious complications such as hemoperitoneum, peritonitis, hemothorax or pneumothorax. All tumors were completed ablation and there was no residual tumor after 1-month follow-up by CECT/MRI. Conclusion Establishment of artificial ascites could make HCC in the hepatic dome clearly displayed by ultrasound and broaden the indications of percutaneous RFA treatment. Percutaneous RFA with artificial ascites appears to be a feasible, safe and effective technique for treating HCC in the hepatic dome.