Abstract: Objective: To explore the value of MSCT used in elder patients or terminal-stage-cancer patients with tracheoesophageal fistula who can't tolerate esophagography. Methods: We performed retrospective analysis on 48 cases highly suspected of tracheoesophageal fistula who treated in our hospital and underwent MSCT and tracheoscopy during 2016-2020. All images were transmitted to PACS after the multiplanar reconstruction of axial, coronary, sagittal, volume reproduction of trachea tree and curved reconstruction of the central surface of the trachea tree. Two doctors read the film in blind method to record whether there was tracheoesophageal fistula and the size of positive cases while the operators did the record detected by tracheoscope. We compared the detection rate and size of the fistula, the big fistula (diameter>1cm), the small fistula (diameter<1cm) and also the size of fistulae in positive cases when used MSCT and tracheoscope respectively. Kappa consistency test was used between the two doctors, chi-square test was used among different evaluation methods while paired-samples t test was adopted to compare the size detected by MSCT and tracheoscope respectively. P<0.05 was indicative of a statistically significant difference. Results: The detection rate of tracheoesophageal fistula was the highest when combined with all the images, and the sensitivity, specificity and accuracy reached 93%, 75% and 86% respectively. There was significant difference in the detection rate of fistula among different methods and the detection rate of sagittal and axial images of the fistula was higher. The detection rate of the big fistula was significantly different among different methods in all positive cases. The detection rate of the big fistula was 100% by combining all the images and the detection rate of the sagittal and the transverse images was inferior to it. There was no significant difference among different methods applied in the detection of small fistula. Among all the positive cases, the size of the fistula measured in tracheoscope was 13.70mm±11.70mm, which was higher than that measured in the images of MSCT which was 10.83mm±10.15mm, there was significant difference between the two methods. Conclusion: MSCT and its routine post-processing methods play an important role in patients who cannot tolerate esophagography.