Twenty-two patients with primary hyperparathyroidism underwent high-resolution magnetic resonance (MR) imaging with local (surface) coils for preoperative localization of enlarged parathyroid glands. The MR studies were interpreted prospectively and the results compared with findings at surgery and the results of computed tomography (CT), ultrasonography (US), and thallium-technetium scintigraphy (TTS). The sensitivity and specificity of MR imaging were .74 and .88, respectively. The sensitivity/specificity for the other modalities were as follows: 74/.95 for CT, .59/.82 for US, and .82/.98 for TTS. Enlarged parathyroid glands displayed a medium-intensity signal on T1-weighted images and a marked increase in intensity on T2-weighted images, but the degree of increase varied considerably.