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The gold standard for diagnosing pulmonary embolism is the CT pulmonary angiogram. This imaging modality provides high-resolution images of the pulmonary arteries and allows for direct visualization of any emboli that may be obstructing blood flow. The CT pulmonary angiogram is highly sensitive and specific for detecting pulmonary embolisms, making it the preferred choice in clinical practice.

In contrast to the CT pulmonary angiogram, a chest X-ray typically lacks the specificity or sensitivity necessary for diagnosing pulmonary embolism, as it may appear normal even in the presence of a significant embolus. Magnetic resonance imaging (MRI), while useful in certain clinical scenarios, is not routinely employed for this purpose due to costs and availability issues compared to CT. An ultrasound of the legs is often used to detect deep vein thrombosis, which can be associated with pulmonary embolism, but it does not provide a direct assessment of the pulmonary arteries themselves. Thus, the CT pulmonary angiogram stands out as the most effective diagnostic tool specifically for confirming pulmonary embolism.