Objective To compare the diagnostic values of ultrasound, multi-slice spiral CT (MSCT) and magnetic resonance imaging (MRI) in hilar cholangiocarcinoma (HC). Methods The study objects were 35 HC patients undergoing selective diagnosis who were admitted to the hospital from January 2014 to August 2018.The retrospective analysis was performed onimaging data of ultrasound, MSCT and MRI, and results of surgical pathology. Taking pathology as state variable, ultrasound and CT and MRI as test variable, the receiver operating characteristic (ROC) curve was drawn to analyze their diagnostic values. Results ROC curve showed that the areas under the curve of ultrasound, MSCT and MRI were 0.690, 0.782 and 0.838, respectively. The area under the curve (AUC) of MRI was the highest, suggesting that its diagnostic efficiency was the best. The corresponding sensitivity and specificity were 92.60% and 75.00%, respectively. In the combination diagnosis of any two of them, AUC of MSCT combined with MRI was the highest (0.940), the corresponding sensitivity and specificity were 77.80%, 100.00% respectivel. the AUC of ultrasound combined with MSCT and MRI was slightly increased (AUC=0.940). But the corresponding sensitivity and specificity were consistent with those of MSCT combined with MRI. Conclusion Compared with that of single ultrasound or MSCT, the sensitivity of MRI is the best for the diagnosis of HC. The diagnostic efficiency of MRI combined with MSCT is better. It is worthy of clinical recommendation.