Sho S, et al. – This prospective study was designed to analyze factors associated with missed parathyroid lesions on preoperative 4–dimensional computed tomographic scans (4D–CTs) and to investigate patterns of commonly observed errors. Investigations suggested that multigland disease was most strongly associated with discordance between preoperative 4D–CTs and intraoperative findings, followed by parathyroid lesion in the inferior position and parathyroid lesion size of 10 mm or less. Awareness of these potential pitfalls would aid surgeons to better leverage this new localization technique in preoperative planning and intraoperative troubleshooting.