In this study, the numerical investigation of the detectability of concrete aggregate segregation in circular concrete-filled steel tubulars (CCFST) based on piezoelectric lead zirconate titanate (PZT) measurement is performed. The stress wave propagation in the concrete core of circular CCFST excited with a surface-mounted PZT actuator is studied with multi-scale and multi-physical field coupling analysis. The piezoelectric effect of PZT patches and its coupling effect with CFSTs are considered. Numerical concrete modeling technology is employed to construct the concrete core composed of randomly distributed aggregates with and without aggregate segregation at different levels, mortar, and an interfacial transition zone (ITZ). The effects of the random distribution of elliptical aggregates, aggregate segregation, and the existence of ITZ in the concrete core on the wave fields in the cross-section and the corresponding voltage response of the embedded PZT sensor are discussed. An evaluation index based on wavelet packet analysis on the output voltage response is defined, and its sensitivity to concrete aggregate segregation is systematically investigated. The multi-scale and multi-physics coupling simulation results indicate that concrete aggregate segregation in the concrete core of CFST members can be efficiently detected based on the stress wave measurement with a PZT sensor.