Meta-analysis finds moderate diagnostic accuracy for CXCR4 PET/CT in primary aldosteronism

A systematic review and meta-analysis of 29 studies found that CXCR4-targeted PET/CT had moderate diagnostic performance for lateralizing primary aldosteronism in patients with aldosterone-producing adenoma. In a bivariate random-effects analysis, pooled sensitivity was 0.807 (95% confidence interval [CI], 0.759–0.848) and specificity was 0.76 (0.665–0.835). The summary receiver operating characteristic curve had an area under the curve of 0.85, while the normalized partial area under the curve was 0.817 for restricted false-positive rates.

Between-study heterogeneity in this bivariate assessment was low, with an I² of 9.8%. The findings position CXCR4-targeted PET/CT as a potential adjunct for selected patients, but the available evidence does not support replacing adrenal venous sampling or PET-guided surgery outside established protocols. The review was conducted in the context of reported high CXCR4 receptor expression in aldosterone-producing adenoma and growing attention to radiotracers such as ⁶⁸Ga-pentixafor.

Its clinical objective was to assess the diagnostic accuracy and utility of CXCR4-targeted PET/CT for identifying the side of aldosterone production in patients evaluated for this tumor type. Following PRISMA guidelines, the researchers searched three databases for studies that had used CXCR4-targeted PET/CT in patients with aldosterone-producing adenoma. The primary outcomes were sensitivity, specificity and diagnostic accuracy, assessed with both univariate and bivariate pooling methods for diagnostic-test-accuracy meta-analysis.

The univariate random-effects model produced a pooled sensitivity of 0.83 (95% CI, 0.776–0.874), specificity of 0.821 (0.700–0.901) and overall accuracy of 0.823 (0.774–0.862). The bivariate estimates were lower than the univariate estimates for both sensitivity and specificity, illustrating that the results varied with the statistical approach used to combine the studies. Predicted performance also differed between positive and negative test results.

In the univariate analysis, the positive predictive value was 0.918 (95% CI, 0.860–0.953), whereas the negative predictive value was 0.671 (0.564–0.763). These estimates showed moderate to substantial heterogeneity across the included studies, with I² values ranging from 43.8% to 67.2%. Published as an open-access systematic review and meta-analysis in BMC Medical Imaging on 20 October 2026, the article is based on 29 studies rather than a new prospective trial or direct comparison in one participant group.

The supplied version states that it was made available after peer-review acceptance, carries a permanent DOI and remains subject to further edits before the final version of record. Taken together, the pooled results support further evaluation of CXCR4-targeted PET/CT as an additional tool in selected patients, while the heterogeneity in predictive values and the limits of the current evidence prevent the imaging method from being presented as a replacement for established pathways.

Subject of Research: Diagnostic accuracy of CXCR4-targeted PET/CT for lateralizing primary aldosteronism in patients with aldosterone-producing adenoma

Article Title: Diagnostic accuracy of CXCR4-targeted PET/CT in primary aldosteronism: a systematic review and meta-analysis of 29 studies

Article References: Qattea, A., Aloraini, D. M., Altaweel, S., Alazmi, M. A. M., Alanazi, F. N., Alfallaj, M. A., Alshahrani, N. A., Aldaham, W., Balkair, Y. M., Alkhawaldeh, I. M., & Tulbah, R. (2026). Diagnostic accuracy of CXCR4-targeted PET/CT in primary aldosteronism: a systematic review and meta-analysis of 29 studies. BMC Medical Imaging. https://doi.org/10.1186/s12880-026-02952-6

Image Credits: AI Generated

DOI: 10.1186/s12880-026-02952-6

Keywords: CXCR4, PET/CT, primary aldosteronism, aldosterone-producing adenoma, diagnostic accuracy, meta-analysis, sensitivity, specificity, medical imaging, 68Ga-pentixafor, Diagnostic, accuracy