Four-dimensional computed tomography (4DCT) has established itself as a valuable imaging modality in the setting of primary hyperparathyroidism (PHPT), demonstrating higher sensitivities compared to ultrasound and technetium-99 m sestamibi single-photon emission computed tomography. 4DCT involves the acquisition of multiple contrast-enhanced CT phases at predefined timepoints after administration of intravenous iodinated contrast material, commonly including non-contrast, arterial, venous, and delayed or late phases. Increased preoperative identification of parathyroid adenomas with 4DCT has allowed for an increase in minimally invasive parathyroidectomy procedures, which offer several advantages over traditional bilateral neck exploration. Similarly, in patients with failed parathyroidectomy, 4DCT outperforms several traditional modalities for parathyroid adenoma localization in reoperative candidates. Still, much debate exists regarding the implementation of 4DCT, particularly concerning the optimal number of phases acquired, which must be balanced against the associated exposure to ionizing radiation. Moreover, varying enhancement patterns in parathyroid adenomas and the relatively long embryological migrational pathway of the parathyroid glands further complicate identification of surgical targets. Four-dimensional magnetic resonance imaging (4DMRI) is an emerging technique that enables high temporally-resolved perfusion imaging without ionizing radiation. However, its use is limited by artifacts, low availability, and limited institutional experience. This chapter aims to review the benefits and limitations of 4DCT in the evaluation of PHPT, provide an approach for the preoperative identification of parathyroid adenomas, and highlight the potential of 4DMRI in this setting.