Objective To observe the differential diagnostic value of MSCT and double contrast barium features of gastric lymphoma and gastric carcinoma. Methods A total of 13 cases of gastric lymphoma and 24 cases of advanced gastric carcinoma confirmed by pathologically underwent MSCT and double contrast barium examination. CT findings, including location, contour, extent, thickness of gastric wall, the enhancement pattern, and the situation of gastric cavity and gastric mucosa, and the encroachment of lymph nodes and other organs were observed. Results Gastric wall thickening involved multiple sites in 10(77% ) cases of gastric lymphoma, and in 4(16% ) cases of advanced gastric carcinoma. CT demonstrated irregular thickening of the gastric wall (7-60 mm)and (8-26 mm), White line sign was observed in 24 cases (100% ) of advanced gastric cancer, but none in gastric lymphoma. The extent more than half of gastric circumference was seen in 12(92%) cases of gastric lymphoma, while none cases of advanced gastric carcinoma. 12(92%) cases of advanced gastric carcinoma and none cases of gastric with deep ulcers Stomach expansion without distal was found in only 1 (8%) cases of gastric, but all cases of advanced gastric cancer. 12(92%) cases were found to have clearly fat planes in gastric lymphoma, but none in advanced gastric carcinoma. Conclusion There are some CT features to differentiate advanced gastric cancer from gastric lymphoma.