Objective To assess the combined application of endoscopic ultrasound and multi-detector row spiral CT in preoperative staging of esophageal cancer. Methods Choose 90 esophageal carcinoma patients who had been checked with endoscopic ultrasound and multi-detector row spiral CT. and do staging of esophageal cancer. Choose the pathological staging of the patient postoperative tumor tissue as the gold standard. Compare the T and N stages of the single use of endoscopic ultrasound and multi-detector row spiral CT, the combination of the two application. Results The combined application in T1, T2 staging accuracy is higher than MDCT, but the difference compared with EUS is less, The combined application in T3, T4 staging accuracy and total accuracy is higher than the single use of EUS and MDCT; The combined application in the N staging of sensitivity, specificity, accuracy and the area under ROC curve were higher than single use of EUS, MDCT. The sensitivity，specificity , accuracy and the area under ROC curve of the single use of endoscopic ultrasound and multi-detector row spiral CT, the combination of the two applications were 68.5%, 70.6%，80.90%, 0.901; 63.0%, 63.3%, 0.853; 86.3%, 82.4%, 85.6%, 0.952. Conclusion Thoracic multi-detector row spiral CT combined with endoscopic ultrasonography can improve the accuracy of thoracic esophageal carcinoma preoperative T, N staging significantly.