Our analysis identified unique first and second order radiomic features that may be used to differentiate parathyroid adenomas from neck lymph nodes on 4D CT. This study was performed retrospectively and at a single institution. Further evaluation with a larger cohort will be useful to develop a radiomic ‘signature’ or model that combines multiple shape, first order and second order features to determine whether a structure is a parathyroid adenoma or lymph node. Further work may also include usage of multiple phases of the 4D CT in the radiomic analysis to improve accuracy, as well as may discerning between additional structures such as exophytic thyroid nodules.