Objective To comparatively analyze the value of 64 slice spiral CT and contrast-enhanced ultrasound in the preoperative diagnosis of cervical lymph node metastasis of papillary thyroid cancer (PTC). Methods 175 patients with PTC confirmed by operation and pathology in our hospital from January 2015 to June 2017 were enrolled in this study. All patients were examined with 64 slice spiral CT and contrastenhanced ultrasound before operation. The accordance rates of different examination methods for preoperative PTC and cervical lymph node metastasis were compared with the pathological results as the golden standard. Results There was no significant difference in the coincidence rates between preoperative CT examination and contrast-enhanced ultrasound in the diagnosis of PTC and cervical lymph node metastasis (P>0.05). In terms of imaging features of cervical lymph node metastasis, preoperative CT examination and postoperative pathology confirmed that 26 cases had obvious calcification in 53 cases, and 22 cases had cystic change in lymph nodes. Preoperative contrast-enhanced ultrasound and postoperative pathology confirmed that there were significant differences of contrast mode, peak intensity, perfusion area, border, the ratio of perfusion area and gray area and PI between patients with metastasis and patients without lymph node metastasis (P<0.05). Conclusion 64 slice spiral CT and contrast-enhanced ultrasound are of great value in the diagnosis of PTC and its preoperative cervical lymph node metastasis.