{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:37:07Z","timestamp":1787017027323,"version":"build-2736575974"},"reference-count":48,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T00:00:00Z","timestamp":1609286400000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Sciences Foundation of China","doi-asserted-by":"crossref","award":["81970262"],"award-info":[{"award-number":["81970262"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Central Funds Guiding the Local Science and Technology Developmentof Sichuan Province","award":["2020ZYD036"],"award-info":[{"award-number":["2020ZYD036"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,12,2]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Systematic searches of PubMed, EMBASE and the Cochrane databases were performed from 1 January 2000 to 1 February 2020, for all studies that used CT or 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>A total of 25 studies, involving a total of 4669 subjects, were identified. The overall analysis revealed a pooled sensitivity of 68% (95% CI: 61% to 74%) and specificity of 57% (95% CI 50% to 65%) for CT\/MRI in identifying unilateral PA. Sensitivity was higher in the contrast-enhanced (CT) group versus the traditional CT group (77% (95% CI 66% to 85%) vs 58% (95% CI 50% to 66%). Subgroup analysis stratified by screening test for PA showed that the sensitivity of the aldosterone-to-renin ratio (ARR) group was higher than that of the non-ARR group (78% (95% CI 69% to 84%) vs 66% (95% CI 58% to 72%)). The diagnostic accuracy of PA patients aged \u226440 years was reported in four studies, and the overall sensitivity was 71%, with 79% specificity. Meta-regression revealed a significant impact of sample size on sensitivity and of age and study quality on specificity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CT\/MRI is not a reliable alternative to invasive AVS without excellent sensitivity or specificity for correctly identifying unilateral PA. Even in young patients (\u226440 years), 21% of patients would have undergone unnecessary adrenalectomy based on imaging results alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-038489","type":"journal-article","created":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T10:00:28Z","timestamp":1609408828000},"page":"e038489","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":37,"title":["Diagnostic accuracy of adrenal imaging for subtype diagnosis in primary aldosteronism: systematic review and meta-analysis"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9441-0291","authenticated-orcid":false,"given":"Yaqiong","family":"Zhou","sequence":"first","affiliation":[{"name":"Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Wang","sequence":"additional","affiliation":[{"name":"Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Licheng","family":"Jiang","sequence":"additional","affiliation":[{"name":"Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Ran","sequence":"additional","affiliation":[{"name":"Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sichao","family":"Chen","sequence":"additional","affiliation":[{"name":"Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peijian","family":"Wang","sequence":"additional","affiliation":[{"name":"Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,12,31]]},"reference":[{"key":"2025121515294190000_10.12.e038489.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.01.052"},{"key":"2025121515294190000_10.12.e038489.2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.33"},{"key":"2025121515294190000_10.12.e038489.3","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/CRD.0000000000000281","article-title":"Primary aldosteronism: cardiovascular risk, diagnosis, and management","volume":"28","author":"Pillai","year":"2020","journal-title":"Cardiol Rev"},{"key":"2025121515294190000_10.12.e038489.4","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S2213-8587(17)30367-4","article-title":"Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study","volume":"6","author":"Hundemer","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2025121515294190000_10.12.e038489.5","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1055\/a-1120-8623","article-title":"Primary aldosteronism: where are we now? Where to from here?","volume":"52","author":"Funder","year":"2020","journal-title":"Horm Metab Res"},{"key":"2025121515294190000_10.12.e038489.6","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-17-0990"},{"key":"2025121515294190000_10.12.e038489.7","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1161\/CIRCULATIONAHA.118.033597","article-title":"Primary aldosteronism: practical approach to diagnosis and management","volume":"138","author":"Byrd","year":"2018","journal-title":"Circulation"},{"key":"2025121515294190000_10.12.e038489.8","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-4061"},{"key":"2025121515294190000_10.12.e038489.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-035411"},{"key":"2025121515294190000_10.12.e038489.10","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-5-200909010-00007"},{"key":"2025121515294190000_10.12.e038489.11","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00136"},{"key":"2025121515294190000_10.12.e038489.12","doi-asserted-by":"publisher","DOI":"10.1059\/0003-4819-155-8-201110180-00009"},{"key":"2025121515294190000_10.12.e038489.13","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-2-9"},{"key":"2025121515294190000_10.12.e038489.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2005.02.022"},{"key":"2025121515294190000_10.12.e038489.15","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X09353452"},{"key":"2025121515294190000_10.12.e038489.16","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1185"},{"key":"2025121515294190000_10.12.e038489.17","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1002\/jso.23963","article-title":"Reversing the established order: should adrenal venous sampling precede cross-sectional imaging in the evaluation of primary aldosteronism?","volume":"112","author":"Asmar","year":"2015","journal-title":"J Surg Oncol"},{"key":"2025121515294190000_10.12.e038489.18","doi-asserted-by":"crossref","first-page":"45","DOI":"10.3109\/00365513.2015.1092047","article-title":"Primary hyperaldosteronism diagnosed with adrenal vein sampling. Characteristics and follow-up after adrenalectomy in a Danish study","volume":"76","author":"Pedersen","year":"2016","journal-title":"Scand J Clin Lab Invest"},{"key":"2025121515294190000_10.12.e038489.19","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jamcollsurg.2019.03.012","article-title":"Influence of adrenal venous sampling on management in patients with primary aldosteronism independent of lateralization on cross-sectional imaging","volume":"229","author":"Campbell","year":"2019","journal-title":"J Am Coll Surg"},{"key":"2025121515294190000_10.12.e038489.20","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1210\/jc.2018-02089","article-title":"Discordance between imaging and adrenal vein sampling in primary aldosteronism irrespective of interpretation criteria","volume":"104","author":"Sam","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"key":"2025121515294190000_10.12.e038489.21","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1148\/rg.2020190080","article-title":"Technical and interpretive pitfalls in adrenal imaging","volume":"40","author":"Nandra","year":"2020","journal-title":"Radiographics"},{"key":"2025121515294190000_10.12.e038489.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2005.01.016"},{"key":"2025121515294190000_10.12.e038489.23","doi-asserted-by":"publisher","DOI":"10.1210\/jc.86.3.1066"},{"key":"2025121515294190000_10.12.e038489.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2004.06.051"},{"key":"2025121515294190000_10.12.e038489.25","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.141.5.497"},{"key":"2025121515294190000_10.12.e038489.26","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.K07E-164"},{"key":"2025121515294190000_10.12.e038489.27","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-2055"},{"key":"2025121515294190000_10.12.e038489.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2010.05.006"},{"key":"2025121515294190000_10.12.e038489.29","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e32834666af"},{"key":"2025121515294190000_10.12.e038489.30","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-1917"},{"key":"2025121515294190000_10.12.e038489.31","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-012-1695-9"},{"key":"2025121515294190000_10.12.e038489.32","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2011.04202.x"},{"key":"2025121515294190000_10.12.e038489.33","doi-asserted-by":"crossref","first-page":"151","DOI":"10.14310\/horm.2002.1342","article-title":"Adrenal venous sampling as a diagnostic procedure for primary hyperaldosteronism: experience from a tertiary referral centre","volume":"11","author":"Salem","year":"2012","journal-title":"Hormones"},{"key":"2025121515294190000_10.12.e038489.34","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-1537"},{"key":"2025121515294190000_10.12.e038489.35","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-3789"},{"key":"2025121515294190000_10.12.e038489.36","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/cen.12374","article-title":"Diagnosing unilateral primary aldosteronism - comparison of a clinical prediction score, computed tomography and adrenal venous sampling","volume":"81","author":"Sze","year":"2014","journal-title":"Clin Endocrinol"},{"key":"2025121515294190000_10.12.e038489.37","doi-asserted-by":"crossref","first-page":"587","DOI":"10.4158\/EP15982.OR","article-title":"A new clinical prediction criterion accurately determines a subset of patients with bilateral primary aldosteronism before adrenal venous sampling","volume":"22","author":"Kocjan","year":"2016","journal-title":"Endocr Pract"},{"key":"2025121515294190000_10.12.e038489.38","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000004986","article-title":"Comparison between adrenal venous sampling and computed tomography in the diagnosis of primary aldosteronism and in the guidance of adrenalectomy","volume":"95","author":"Zhu","year":"2016","journal-title":"Medicine"},{"key":"2025121515294190000_10.12.e038489.39","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1038\/jhh.2016.61","article-title":"Significance of adrenal computed tomography in predicting laterality and indicating adrenal vein sampling in primary aldosteronism","volume":"31","author":"Kamemura","year":"2017","journal-title":"J Hum Hypertens"},{"key":"2025121515294190000_10.12.e038489.40","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1111\/cen.13442","article-title":"Discordance between imaging and immunohistochemistry in unilateral primary aldosteronism","volume":"87","author":"Nanba","year":"2017","journal-title":"Clin Endocrinol"},{"key":"2025121515294190000_10.12.e038489.41","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2017-01774"},{"key":"2025121515294190000_10.12.e038489.42","doi-asserted-by":"crossref","first-page":"1942","DOI":"10.1038\/s41440-019-0310-y","article-title":"Primary aldosteronism subtype discordance between computed tomography and adrenal venous sampling","volume":"42","author":"Aono","year":"2019","journal-title":"Hypertens Res"},{"key":"2025121515294190000_10.12.e038489.43","doi-asserted-by":"crossref","first-page":"830","DOI":"10.4158\/EP-2019-0009","article-title":"The potential clinical application of a lower bilateral adrenal limb width ratio (L\/RW) in patients with bilateral primary hyperaldosteronism","volume":"25","author":"Li","year":"2019","journal-title":"Endocr Pract"},{"key":"2025121515294190000_10.12.e038489.44","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1210\/jc.2018-01324","article-title":"Adrenal venous sampling with or without adrenocorticotropic hormone stimulation: a meta-analysis","volume":"104","author":"Laurent","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"key":"2025121515294190000_10.12.e038489.45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4158\/EP.15.S1.1","article-title":"The American association of clinical endocrinologists and American association of endocrine surgeons medical guidelines for the management of adrenal incidentalomas","volume":"15(Suppl 1)","author":"Zeiger","year":"2009","journal-title":"Endocr Pract"},{"key":"2025121515294190000_10.12.e038489.46","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-2885"},{"key":"2025121515294190000_10.12.e038489.47","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000000708"},{"key":"2025121515294190000_10.12.e038489.48","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.114.04453"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-038489","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T23:29:54Z","timestamp":1765841394000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-038489"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":48,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,31]]},"published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1136\/bmjopen-2020-038489"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-038489","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]}}}