OBJECTIVE To determine whether rapid, dynamic SPECT imaging with Tc-99m labeled red blood cells was technically feasible and of value in the detection of cavernous hemangiomas of the liver. METHODS The acquisition protocol for Tc-99m labeled red blood cell imaging of hepatic hemangiomas was modified with six sequential 3-minute SPECT images replacing the planar flow phase. Delayed 20-minute SPECT of the liver was then performed 2 hours later. RESULTS The authors present examples of pathologically proven positive and negative cases and retrospectively review their patient series. Examination of 19 patients with 41 lesions revealed no evidence of a false-positive examination results and only one false-negative result. Only one lesion seen to be positive with a 2-hour delayed study was not seen within 18 minutes. Lesions as small as 1.0 cm could be detected with a 3-minute SPECT. CONCLUSIONS Rapid, dynamic early SPECT hemangioma imaging is feasible, provides images with relatively good quality, and can replace the planar flow phase.