In esophageal cancer staging, the radiologic approach is represented by tumor identification, preoperative staging, and re-staging after neoadjuvant therapies. At present, while barium radiography shows a high sensitivity for early and advanced tumors, endoscopy is always necessary for confirmation. CT and MRI are the gold standard for preoperative staging of advanced (T4) esophageal cancer and for evaluation of distant metastasis; however they still show a low sensitivity in the study of possible regional lymph node involvement, in differentiating residual disease and scarring; in particular the esophageal wall cannot be carefully examined.