Purpose Pheochromocytoma (PH) is a rare catecholaminesecreting tumor that arises from chromaffin tissue within the adrenal medulla and extra-adrenal sites; commonly it is sporadic, and malignant PH accounts for about 10% of all cases. Several imaging modalities have been used for the diagnosis and staging of this tumor: functional imaging using radio-labelled metaiodobenzylguanidine and, more recently, $^{18}F$-fluorodeoxyglucose positron emission tomography ($^{18}F$-FDG PET/CT), which offers substantial sensitivity and specificity to correctly detect metastatic PH and helps to identify patients suitable for treatment with radiopharmaceuticals. The aim of our study was to compare CT, $^{18}F$-FDG PET/CT, and $^{123}I$-metaiodobenzylguanidine single photon emission tomography ($^{123}I$-MIBG SPECT) as feasible methods to restage patients diagnosed histologically with PH. Methods We retrospectively evaluated 38 patients (27 females and 11 males; mean age: $44{pm}15$ years) with malignant PH documented histologically after surgical intervention. These patients underwent CT, $^{18}F$-FDG PET/CT, and $^{123}I$-MIBG SPECT. Results $^{18}F$-FDG PET/CT showed positive results for neoplastic tissue in 33/38 patients (86.8%) and negative in 5/38 (13.2%), in concordance with CT alone. $^{123}I$-MIBG SPECT was positive in 30/38 patients (78,9%) and negative in 8/38 (21.1%). No differences in lesion numbers were found between $^{18}F$-FDG PET/CT and CT, whereas a difference could be demonstrated between $^{18}F$-FDG PET/CT and $^{123}I$-MIBG SPECT. Conclusion $^{18}F$-FDG PET/CT could more accurately restage patients with PH than CT and $^{123}I$-MIBG SPECT, also in the absence of a staging study.