We performed a systematic review and metaanalysis of the performance of <sup>68</sup>Ga-DOTA–conjugated somatostatin receptor–targeting peptide (<sup>68</sup>Ga-DOTA-SST) PET in the detection of pheochromocytomas and paragangliomas (PPGLs). <b>Methods:</b> PubMed and Embase were searched until May 8, 2018. We included studies that reported the detection rate of <sup>68</sup>Ga-DOTA-SST PET in patients with PPGLs. Detection rates were pooled using a random-effects model. Subgroup analyses and metaregression were performed to explore the cause of heterogeneity. <b>Results:</b> Thirteen studies were included for qualitative synthesis. Per-lesion detection rates of <sup>68</sup>Ga-DOTA-SST PET were consistently higher (ranging from 92% to 100%) than other imaging modalities, including <sup>18</sup>F-fluorohydroxyphenylalanine (<sup>18</sup>F-FDOPA) PET, <sup>18</sup>F-FDG PET, and <sup>123/131</sup>I-metaiodobenzylguanidine (<sup>123/131</sup>I-MIBG) scintigraphy. However, in patients with polycythemia/paraganglioma syndrome, the detection rate of <sup>68</sup>Ga-DOTA-DOTATATE PET was 35%. Nine studies (215 patients) with no specific inclusion criteria for subtype were quantitatively synthesized. The pooled detection rate was 93% (95% confidence interval [CI], 91%–95%), which was significantly higher than that of <sup>18</sup>F-FDOPA PET (80% [95% CI, 69%–88%]), <sup>18</sup>F-FDG PET (74% [95% CI, 46%–91%]), and <sup>123/131</sup>I-MIBG scan (38% [95% CI, 20%–59%], <i>P</i> < 0.001 for all). A greater prevalence of head and neck paragangliomas was associated with higher detection rates of <sup>68</sup>Ga-DOTA-SST PET (<i>P</i> = 0.0002). <b>Conclusion:</b><sup>68</sup>Ga-DOTA-SST PET exhibited superior performance for lesion detection, over other functional imaging modalities, in patients with PPGLs, with the exception of polycythemia/paraganglioma syndrome. This might suggest <sup>68</sup>Ga-DOTA-SST PET as a first-line imaging modality for the primary staging of PPGL or the restaging of PPGL with unknown geneti...