AbstractThe diagnosis and accurate staging of esophageal adenocarcinoma remains one of the greatest challenges for non‐invasive imaging techniques. All modalities have limitations and require a rational application of combined tools in order to assess the extent of loco‐regional tumor and distant metastatic disease. The fundamental role remains defining organ‐confined disease and mapping non‐organ confined disease. Endoscopic ultrasound combined with multislice computed tomography (CT) is the mainstay of morphologic loco‐regional staging. In recent years, functional metabolic 2‐[fluorine‐18]fluoro‐2‐deoxy‐D‐glucose (FDG)–positron emission tomography (PET) has emerged as a particularly useful adjunct to detect occult metastatic disease, to predict response to neoadjuvant therapy and to document recurrent disease. The current imaging algorithm and new developments in imaging assessment will be reviewed. J. Surg. Oncol. 2005;92:191–202. © 2005 Wiley‐Liss, Inc.