Abstract: Because of the poor prognosis for patients with esophageal cancer and the risks associated with surgical intervention, accurate staging is essential for optimal treatment planning. Positron emission tomography (PET) with ¹⁸F-fluorodeoxyglucose (FDG) is a useful adjunct to more conventional imaging modalities in this setting. ¹⁸F-FDG PET is not an appropriate first-line diagnostic procedure in the detection of esophageal cancer and is not helpful in detecting local invasion by the primary tumor. However, ¹⁸F-FDG PET is superior to anatomic imaging modalities in the ability to detect distant metastases. Metastases to the liver, lungs, and skeleton can readily be identified at ¹⁸F-FDG PET. In addition, ¹⁸F-FDG PET has proved valuable in determining the respectability of disease and allows scanning of a larger volume, which is possible with computed tomography. Recurrent disease is readily diagnosed and differentiated from scar tissue with ¹⁸F-FDG PET. In addition, ¹⁸F-FDG PET may play a valuable role in the follow up of patients who undergo chemotherapy and radiation therapy, allowing early changes in treatment for unresponsive tumors. The management of most patients with esophageal cancer can be improved with the use of ¹⁸F-FDG PET.