Abstract: Objective: To investigate the imaging characteristics and material tissue characteristics of parathyroid adenoma(PA) with four-dimensional dual energy computed tomography(4D-DECT), and to evaluate the value of localization and qualitative diagnosis. Materials and methods: the clinical and 4D-DECT imaging data of 53 patients with PA confirmed by operation and pathology were retrospectively analyzed. The CT signs were observed and recorded, and CT value, iodine concentration, Rho, Z value and DEI were measured and analyzed. Results: In 53 patients, 52(98.11%) cases of PA were solitary, 1(1.89%) case with multiple nodules, a total of 54 lesions were found, 32(59.26%) of which were located in the trachea-esophageal sulcus, 10(18.52%) lesions were ectopic adenomas, and 22(40.74%) lesions showed "short line sign", 14(25.93%) showed "polar vessel sign"; there was no significant difference in CT value between PA and thyroid in arterial phase(90 kV), but the CT value of PA, thyroid and lymph nodes were different in non-contrast, arterial phase(M 0.5, 150 kV) and venous phase(90 kV, M 0.5, 150 kV). Iodine concentration, Z value and DEI of lymph nodes in arterial and venous phase were significantly lower than those of PA and thyroid, iodine concentration, Z value and DEI of PA in venous phase were significantly lower than those of thyroid; Rho of thyroid in arterial and venous phase was significantly higher than that of PA, and Rho of PA in arterial phase was significantly higher than that of lymph nodes. Conclusion: 4D-DECT can better display the imaging features of PA, and can also provide the analysis of iodine concentration and a variety of material tissue characteristics information, which is helpful to improve the diagnostic accuracy of PA.