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^123/131I-metaiodobenzylguanidine (MIBG) scintigraphy has shown a high specificity for imaging pheochromocytoma and paraganglioma, but with low sensitivity because of low spatial resolution. ¹²⁴I-MIBG PET may be able to overcome this limitation and improve the staging of patients with (suspected) pheochromocytoma. We analyzed the sensitivity, specificity, and positive and negative predictive values of ¹²⁴I-MIBG PET in 43 consecutive patients with suspected (recurrence of) pheochromocytoma using histopathologic (n = 25) and clinical validation (n = 18) as the standard of truth. Furthermore, we compared the detection rate of ¹²⁴I-MIBG PET versus contrast-enhanced (CE) CT on a per-patient and per-lesion basis in 13 additional patients with known metastatic malignant pheochromocytoma. ¹²⁴I-MIBG PET/CT was positive in 19 (44%) of 43 patients with suspected pheochromocytoma …