Purpose To explore multi-slice spiral CT (MSCT) in differential diagnosis of esophageal leiomyoma and esophageal carcinoma.Material and Methods Plain chest CT scan and enhanced inspection image of 26 patients with esophageal leiomyoma and 68 patients with esophageal carcinoma at the same term which had been confirmed by surgery and pathology were retrospectively analyzed.Characteristics such as focus size,morphology,density and tumor-air surface,etc were recorded and compared.Results MSCT of esophageal leiomyoma showed uniform density,possible calcification,polylimited influence of esophageal wall,scarcity of depression in focus niche,smooth tumor-air surface,low degree of enhanced amplification,and cerioid expansion of related lumen of larger focus.However,MSCT in esophageal carcinoma was represented by thickened annulus of esophageal wall,no calcification of focus,familiarity of depression in focus niche,rough tumor-air surface and intermediate degree strengthening.Differences of contrast of calcification,polylimited influence of esophageal wall,scarcity of depression in focus niche,smooth tumor-air surface in sophageal leiomyoma with that of esophageal carcinoma were statistically significant (P＜0.05).Conclusion MSCT can accurately identify sophageal leiomyoma and esophageal carcinoma,offering evidence for clinical diagnosis and treatment.