Scintigraphic imaging of parathyroid glands has been the subject of new developments. Efficiency of the technique has been improved by the use of a new agent Tc-99m sestamibi (MIBI). A meta-analysis study of the literature confirmed the superiority of this agent toward the conventional Tc/T1201. Various protocols have been proposed for parathyroid imaging with MIBI they are described with a comparison of their advantages and drawbacks. The superiority of a two isotopes protocol using Tc-99m sestamibi with Iodine 123 and a subtraction processing seems proven. Moreover, this latter protocol allows the use of lateral views resulting in a higher accuracy. The visualization of hyperplasic glands is also improved by this technique. Comparison of ultrasonography versus Tc-99m sestamibi scintigraphy is discussed in the light of recent published materials. The scintigraphy appears more sensitive than ultrasonography and specially in the detection of mediastinal ectopic glands. Finally the exact role of radionuclid imaging of the parathyroids in the management of primary hyperparathyroidism is described.