Imaging diagnosis of gastric stump carcinoma ZHANG Xiao-peng, TANG Lei. Department of Imaging, Peking University School of Oncolocy, Beijing Institute for Cancer Research, Beijing 100142, China Corresponding author: ZHANG Xiao-peng, E-mail: zxp@bjcancer.org Abstract X-ray double contrast imaging, CT and MRI are the main evaluation modalities of gastric stump carcinoma (GSC). The clinical applications include detection, staging, operation assistance, follow-up and therapeutic effect evaluation.“Fake-tumor sign”and“fake niche sign”should be aware during X-ray double contrast imaging of GSC. CT and MRI high-resolution imaging and diffusion-weighted MR imaging can be helpful in the detection of GSC. CT and MRI are the most useful staging modalities. The accuracy of T staging could reach 85% or more after combined ax-, cor- and sag- planes. The density of para-stomach fat space could increase or with strands because of the fibrous scar and venous congestion. The morphology of serosa should be taken into consideration in case of T3 over-evaluation. The change of lymph drainage caused by operation should be aware during the evaluation of lymph node metastasis. The enhanced imaging should be preformed to discriminate the fibrous lumps around remnant stomach or large vessels from lymph nodes. The key to improve the N-staging level is to build the artificial intelligence model combining full-scale biological behavior index. CT angiography can be used to help the pre-operation evaluation of feeding arteries of remnant stomach, and their variants also, which can contribute to safe and high-performance operation. CT and MRI can be used in the evaluation of therapeutic effect of chemotherapy in GSC .