Cancer stomach is considered the third most common lethal disease worldwide . Although the usage of double contrast study helps in early detection of any small gastric lesions, wall invasion extent as well as presence or absence of distant metastasis . The definite function of MDCT is to differentiate between benign and malignant gastric tumor and assess the stage and metastatic extent of gastric carcinoma, for assessing treatment protocol between palliative or radical surgical treatment. In our study, the use of contrast agents is essential as there must be adequate distension of the stomach. If the entire stomach is not well distended, disease must be over looked or, conversely, the collapsed gastric wall may mimic disease .
On the other hand, MDCT help in evaluation of treatment response. It is also considered as one of the important prognostic factors through tumor extent evaluation . In our study, 40 patients underwent analytical study, correlation, and comparison of MDCT radiological data with histopathologically proved results.
We found male patients were more affected (25/40) (62.5%) in comparison with female patients (15/40) (37.5%), that undergoes with Macdonald et al. , who found that gastric cancer are more common in male patients in comparison to female patients.
The majority of patients had complaints at the diagnosis time of the previous study of Allum et al. , who found that dyspepsia, dysphagia, weight loss, and anemia were the most common clinical presentations. This coincides with the findings in which the most frequent clinical presentation was vomiting after a meal in 30 patients followed by loss of appetite in 20 patients, weight loss in 9 patients, and epigastric pain in 6 patients.
According to Perez and Brady  who found that 50% of study cases were with focal mural thickness, 25% were with polypoidal soft tissue lesions but only 5% show diffuse mural thickening with narrowing of the lumen and that is in contrary with our results that found about 33 patients showed circumferential gastric wall thickening (82.5%) but in few cases 3 and 2 patients (7.5% & 5%) polypoid, fungating, and ulcerating masses were found.
According to Horton and Fishman  analysis who found that the liver was the most common organ for distant metastasis and in our result there is a high degree of agreement as about half of the study cases metastasized to liver followed by regional L. Ns metastasis and peritoneal deposits.
The stomach layers are best evaluated in the arterial phase of contrast enhancement when the stomach is free of contrast . In our study, gastric tumor enhancement was identified in all patients in the arterial phase, all of them show homogenous enhancement. On MDCT, the extension of tumor load was categorized as follows: T0, no proof of alteration of the gastric wall with even perigastric fat around; T1, infiltration of the gastric mucosa or submucosa ; T2, invasion to muscularis propria ; T3, invasion to subserosa ; and T4, invasion to serosa and adjacent organs or structures [18, 19].
In the present study, the sensitivity of MDCT in recognition and evaluation of gastric neoplasms was documented parallel with the histopathological results as a gold standard. In the current study, there is a significant relationship between pathological and CT staging by using of thin-slice axial CT as we found that CT was specific and accurate in diagnosis of all stages of gastric cancer with specificity ranged between 93 and 97% and accuracy ranged between 9 and 92.5%.
The present study showed that MDCT gives the highest sensitivity (90%) in stage IV, but the lowest on of stages I and II. This correlates with Kumano et al.  results, who reported that MDCT has sensitivities in the range of 68.8–96.2% in the detection of gastric cancers. According to our recent statistics, the accuracy and sensitivity of T3 are 70% and 100%, while that of T4 was 70 and 44, respectively.
There are points of strengths in the current study; as our study was done on a tertiary cancer center promoting the possibility of checking as many suspecting cases with follow up, using the advanced MDCT machine of 128-row detectors giving the chance for more accuracy and detection of small lesions with its first metastasis. Furthermore, the detection of our patients with gastric carcinoma included different stages and detection of different metastasis unpredicted sites either presented as local tumor spread or in distant sites. Finally, our study correlates all the MDCT findings with the histopathological results giving more confidence.
On the contrary, there are few points of limitations could not be evaded and should be recorded; our patient sample is limited, but inevitably our next research will include large sample in multi-centric study, most cases were presented in advanced stage, and deficiency of post-operative or post-therapy follow up to show the impact of our results upon the management plan but another research could be intensive study that point.