AVS-referenced diagnostic performance of 68Ga-Pentixafor PET/CT for detecting unilateral disease in primary aldosteronism: a systematic review and meta-analysis.

​BACKGROUND: Differentiation of unilateral from bilateral primary aldosteronism (PA) is crucial for identifying patients who are likely to be cured by adrenalectomy. This review evaluated the adrenal vein sampling (AVS)-referenced performance of 68Ga-Pentixafor positron emission tomography/computed tomography (PET/CT) for detecting unilateral aldosterone-producing lesions. METHODS: We searched PubMed, Web of Science, and Embase for relevant articles published up to May 2025. This review followed a prespecified population, index test, comparator, outcome, and study design (PICOS) framework. Using Meta-DiSc v.1.4 and Stata software, sensitivity, specificity, likelihood ratios, and diagnostic odds ratios were pooled. RESULTS: Twelve studies met the inclusion criteria. Hu et al., 2023 was retained only for qualitative description and excluded from the primary quantitative synthesis because of its clear outlying influence; thus, 11 studies were included in the main pooled synthesis. The pooled sensitivity and specificity were 0.75 (95% CI: 0.67-0.82) and 0.81 (95% CI: 0.74-0.87), respectively. The positive and negative likelihood ratios were 4.05 and 0.31, respectively. The diagnostic odds ratio (DOR) was 12.59 (95% CI: 7.21-22.01). CONCLUSION: 68Ga-Pentixafor PET/CT showed fair concordance with AVS-based lateralization and may have a role as an adjunctive test in selected clinical scenarios, especially when AVS is unavailable, non-diagnostic, or technically demanding. Further prospective trials with validation against postoperative biochemical and clinical outcomes are warranted. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251067457, identifier CRD420251067457.