Agreement Between Molecular Imaging and Adrenal Vein Sampling for Localization in Primary Aldosteronism: A Systematic...

Area of Science:

• Endocrinology
• Radiology
• Medical Imaging

Background:

• Primary aldosteronism is a frequent cause of hypertension.
• Surgical cure is possible for localized primary aldosteronism.
• Adrenal vein sampling (AVS) is the traditional localization method, but molecular imaging offers a noninvasive alternative.

Purpose of the Study:

• To systematically synthesize studies comparing molecular imaging and AVS for primary aldosteronism localization.
• To evaluate the agreement between these diagnostic modalities.

Main Methods:

• Systematic review of 20 studies comparing molecular imaging and AVS.
• Agreement assessed using positive/negative percent agreement and Cohen's κ.
• Analyses were tracer-specific due to heterogeneity; sensitivity analyses were performed.

Main Results:

• Moderate agreement was observed between molecular imaging and AVS across tracers (positive percent agreement: 0.6-0.9; negative percent agreement: 0.5-0.9).
• Cohen's κ values indicated moderate-to-strong agreement (0.33-0.93).
• No consistent directional bias was found between modalities in reciprocal analyses.

Conclusions:

• Molecular imaging demonstrates moderate, variable agreement with AVS for primary aldosteronism localization.
• Molecular imaging may function as an adjunct or alternative to AVS.
• Further research on patient outcomes is required to establish clinical utility.