Objective To investigate the imaging features of gastric neuroendocrine carcinoma (G-NEC) and gastric stromal tumor (GST) under multi-slice spiral CT scan. Methods A retrospective study was carried out on the pathologically identified G-NEC (n=21) and GST patients (n=34) who were hospitalized in our hospital from May 2010 to July 2019. The clinical data and CT features (including tumor location, tumor longest diameter, tumor growth pattern, tumor number and tumor morphology) were compared between the two groups. SPSS statistics 22.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for comparison between groups, and logistic regression analysis was applied to screen the independent differentiators between GST and G-NEC. Results In general data, G-NEC was more common in men, while GST was more common in women. Gender can be used as an independent distinguishing factor between GST and G-NEC (OR=0.02, P=0.015). G-NEC group (60.9±10.7 years old) and GST group (60.5±13.3 years old) had no statistical significance in age (P>0.05). Through the analysis of the CT findings of the two groups of patients, the location of the tumor (P<0.001), lymph node metastasis (P=0.012), liver metastasis (P=0.006), tumor growth pattern (P=0.014), tumor morphology ( P<0.001), mucosal integrity (P=0.001), and tumor boundary (P<0.001) were all significant differences in clarity. Subsequently, a multivariate analysis of the above characteristics was performed. Gender (OR=0.02, P=0.015) and tumor morphology (OR=18.61, P=0.022) can be used as independent distinguishing factors between GST and G-NEC, and tumor morphology was the most significant distinguishing factor between GST and G-NEC. Conclusion CT scan is of certain clinical significance for differential diagnosis between G-NEC and GST.