Background: Ventilation perfusion single photon emission computed tomography (V/Q SPECT) and CT pulmonary angiography have all been used in the diagnosis of acute PE. Previous studies have shown higher sensitivity and specificity and a marked decrease in the non-diagnostic rate of V/Q SPECT than planar scan. Purpose: To systematically review and perform a meta-analysis of published data on the performance of V/Q SPECT in the diagnosis of acute PE. Material and Methods: A comprehensive computer search was conducted on literature published through 31 December 2013 in an effort to find relevant articles on the diagnostic performance of V/Q SPECT in the diagnosis of PE patients. Pooled sensitivity, specificity, negative likelihood ratio (LR), and positive LR, the area under the receiver-operating characteristic (ROC) curve of V/Q SPECT in the diagnosis of PE patients were calculated. Results: Nine studies, comprising a total sample size of 3454 patients, were included in our meta-analysis. The pooled sensitivity, specificity of V/Q SPECT in the diagnosis of acute PE patients, calculated on a per-patient-based analysis, was 96% (95% confidence interval [CI], 95-97%), 97% (95% CI, 96-98%). The pooled negative LR, positive LR of V/Q SPECT in acute PE patients was 0.06 (range, 0.02-0.19) and 16.64 (range, 9.78-31.54). The area under the ROC curve of V/Q SPECT in the diagnosis of acute PE patients was 0.99 on a per-patient-based analysis. Conclusion: V/Q SPECT is an accurate method in acute PE patients with high sensitivity and high specificity in the diagnosis of PE.