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

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​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 68 Ga-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 68 Ga-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.