The widespread use of minimally invasive surgical techniques for treating primary hyperparathyroidism has been made possible by the availability of preoperative imaging for localizing enlarged parathyroid glands. Parathyroid imaging methods include ultrasonography, radionuclide imaging with technetium-99m sestamibi, and more recently, four-dimensional computerized tomography based on the perfusion pattern over time. These imaging techniques are used to plan surgery in patients with biochemically confirmed primary hyperparathyroidism, 85%–90% of whom harbor a solitary parathyroid adenoma. However, the diagnosis of primary hyperparathyroidism should not be based on parathyroid imaging results, because the finding of a putative enlarged parathyroid gland with any imaging technique may represent a false-positive result.