What is considered the gold standard test for pulmonary embolism (PE)?

The gold standard test for pulmonary embolism (PE) is pulmonary angiography. This invasive procedure allows for direct visualization of the pulmonary arteries and is highly accurate in diagnosing PE. During pulmonary angiography, a contrast dye is injected into the pulmonary arteries, and X-ray images are taken to detect blockages caused by blood clots. The ability to directly observe these clots enables clinicians to confirm the diagnosis definitively.

While other modalities like CT pulmonary angiogram are widely used due to their non-invasive nature and effectiveness, they are not as definitive as pulmonary angiography. The V/Q scan can indicate the presence of a PE but is less specific and sensitive than pulmonary angiography. Chest X-ray is often used as a preliminary assessment but does not provide sufficient information to confirm or rule out a PE. Therefore, pulmonary angiography remains the standard against which other diagnostic tests for pulmonary embolism are measured.