Perioperative imaging has revolutionized parathyroid surgery, enabling focused approaches and minimizing complications in hyperparathyroidism management. Preoperative localization typically begins with neck ultrasonography and Tc99m sestamibi scintigraphy, which are effective for identifying solitary adenomas. Advanced imaging modalities like four-dimensional computed tomography (4D-CT), magnetic resonance imaging (MRI), and choline positron emission-computed tomography (choline-PET-CT) improve localization in complex scenarios, such as multiglandular disease, ectopic glands, or prior surgery. Intraoperative imaging innovations, including near-infrared autofluorescence (NIRAF), indocyanine green (ICG) angiography, Raman spectroscopy, and carbon nanoparticle use, enhance gland identification and vascularity assessment, reducing postoperative hypocalcemia. Selective parathyroid venous sampling and arteriography are reserved for challenging re-operative cases. Autofluorescence-guided surgery has shown promising results in increasing parathyroid detection rates and decreasing inadvertent gland excision. Despite technological advances, optimal outcomes rely on combining imaging modalities with surgical expertise. This chapter comprehensively reviews current imaging techniques, their clinical applications, advantages, limitations, and evolving trends in improving surgical precision and patient outcomes in parathyroid surgery.