Performance of Pentixafor PET/CT in identifying unilateral primary aldosteronism: A meta-analysis

To evaluate the diagnostic performance of Pentixafor PET/CT for identification of unilateral primary aldosteronism (PA).

The PubMed and Embase databases were searched to identify relevant articles published through March 2025. Studies using various combinations of adrenal venous sampling (AVS), clinical information, pathologic and post-surgical follow-up data as reference standard to report the diagnostic accuracy of Pentixafor PET/CT in identifying unilateral PA were included. The pooled sensitivity, specificity, and area under the summary receiver-operating characteristics curve (AUC) were determined by using bivariate random-effects model. We also included studies in which patients who had undergone both Pentixafor PET/CT and a successful AVS can be identified. The PET/CT result was considered in agreement with AVS when AVS showed unilaterally increased aldosterone secretion on the same side as the abnormality seen on PET/CT or when AVS showed symmetric aldosterone secretion and PET/CT revealed bilateral or no unilateral abnormality.

Seven studies with 603 patients were eligible for assessing diagnostic accuracy. The pooled sensitivity, specificity, and AUC value for Pentixafor PET/CT in indentifying unilateral PA were 80 % (95 % CI, 70-87 %), 91 % (95 % CI, 86-94 %), and 0.91 (95 % CI, 0.89-0.94), respectively. Five studies with 189 patients were eligible for assessing agreement between the results from Pentixafor PET/CT and AVS. The proportion of patients whose PET/CT results agreed with those of AVS was 79.3 % (150/189).

This meta-analysis showed that Pentixafor PET/CT has high diagnostic accuracy for the identification of unilateral PA. In addition, Pentixafor PET/CT results are also in good agreement with those of AVS as to indicating left or right side of aldosterone hypersecretion, or no lateralization. These results confirmed the promising role of Pentixafor PET/CT in PA lateralization.