[en] Full text: For minimally invasive parathyroid surgery, accurate pre-operative localization is mandatory. Superior parathyroid glands are more posterior than inferior glands and commonly found in the tracheo-esophageal groove. Surgery for an inferio-posterior gland (superior gland) is difficult because of its proximity to the recurrent laryngeal nerve. Preoperative knowledge of whether the parathyroid gland is superior or inferior facilitates exploration. Materials and Methods: Out of 31 patients who underwent MIBI parathyroid imaging, 26 had positive scans and underwent successful surgical resection. Standard parathyroid imaging protocol with early and delayed imaging was used with the addition of SPECT/CT at 15 minutes. Two experienced readers independently evaluated four image sets (early and delayed planar imaging, SPECT, and SPECT/CT) for adenoma detection and localization at 7 possible sites right/left superior, right/left inferior, right/left intra-thyroidal, and ectopic. Infero-posterior location was considered to be superior parathyroid adenoma. Results: SPECT and SPECT-CT detected all 26 positive cases where as dual phase imaging detected 24 cases and early planar imaging detected only 21 cases. Localization of adenoma (superior or inferior) was done correctly in 16 (62%) and 22 (84.61%) cases with SPECT and SPECT-CT respectively. Certainty of adenoma characterization as superior or inferior was significantly higher with SPECT-CT in comparison to SPECT alone or planar dual phase images. Large adenomas with increased uptake were difficult to call superior or inferior due to adhesion along whole length of posterior aspect of thyroid. Conclusion: SPECT/CT shows clear advantage over SPECT alone or dual phase imaging for localization and characterization of parathyroid adenoma as superior or inferior for minimal invasive surgery