The most common indication for parathyroid imaging is hyperparathyroidism, which is caused by a solitary parathyroid adenoma in most patients. The primary function of parathyroid imaging is localization of the abnormal parathyroid gland, enabling the surgeon to pursue a minimally invasive resection. Ultrasound and (99m)Tc sestamibi scintigraphy are the mainstays for the preoperative localization of culprit lesions. The emerging modality of SPECT-CT can improve the sensitivity of (99m)Tc sestamibi scintigraphy and its use is encouraged when available. CT and MR imaging are useful as adjuncts, particularly as anatomic correlates to suspected ectopic glands on (99m)Tc sestamibi scintigraphy that are inaccessible to ultrasound. In cases of suspected parathyroid carcinoma, preoperative CT or MR imaging is recommended for surgical planning.