To assess the clinical value of dual time point imaging (DTPI) fluorine-18fludeoxyglucose (18F-FDG) positron emission tomography (PET)/CT in differentiating malignancy and benign disease of patients with focally increased gastric uptake.Patients who present focally increased 18F-FDG uptake in gastric wall on conventional PET/CT imaging received delayed imaging. PET/CT scans were acquired at 1 and 2 hours (early and delayed imaging) after 18F-FDG injection. The maximum standardized uptake value (SUV) was calculated. The SUVmax of the early and delayed imaging acquisition were signed S1 and S2, respectively. The receiver operating characteristic curve (ROC) of the S1, S2, and the retention index (RI) were drawn to find the best cut-off point value for differential diagnosis. Sensitivity, specificity, Youden index, and the area under the curve (AUC) were calculated, respectively.From September 2010 to May 2015, 74 patients (56 male and 18 female; age of 57 ± 12 years; range, 32–86 years) referring for areas of focally increased uptake of 18F-FDG in gastric wall received delayed imaging. The S1 was 5.0 ± 1.4 (range, 1.9–11.3), and S2 was 5.9 ± 2.7 (range, 1.0–16.3). The SUVmax were increased in 52 patients in delayed imaging, with 85% (44/52 cases) appeared malignant; decreased in 20 patients, and 90% (18/20 cases) were benign; 2 patients of benign had not changed. The change of SUVmax between malignant and benign was significant difference (t = −5.785, P = 0.000).Taking the S1, S2, and RI higher than 4.6%, 5.1%, and 13% as positive diagnostic criteria, the sensitivity were 65.2%,87.0%, and 87.0%, respectively; the specificity were 64.3%, 82.1%, and 89.3%; the Youden index were 0.332, 0.693, and 0.770; AUC were 0.635 (95% confidence intervals (95% CI) 0.507–0.764), 0.873 (95% CI, 0.786–0.961), and 0.923 (95% CI, 0.854–0.992).DTPI is more precise to distinct malignant from benign gastric diseases compared with conventional imaging, and it is readily accessible.