Diagnostic Accuracy of Adrenal Imaging for Subtype Diagnosis in Primary Aldosteronism: Systematic Review and Meta-Analysis

Objectives: Accurate subtype classification in primary aldosteronism (PA) is critical in assessing the optimal treatment options. This study aimed to evaluate the diagnostic accuracy of adrenal imaging for unilateral PA classification. Methods: Systematic searches of PubMed, EMBASE, and the Cochrane databases were performed from January 1, 2000, to February 1, 2020, for all studies that used computed tomography (CT) or magnetic resonance imaging (MRI) in determining unilateral PA and validated the results against invasive adrenal vein sampling (AVS). Summary diagnostic accuracies were assessed using a bivariate random-effects model. Subgroup analyses, meta-regression and sensitivity analysis were performed to explore the possible sources of heterogeneity. Result: A total of 25 studies, involving a total of 4669 subjects, were identified. The overall analysis revealed a pooled sensitivity of 68% (95% confidence interval [CI]: 61 to 74) and specificity of 57% (95% CI: 50 to 65) for ...