BACKGROUND: With ongoing technical developments, MRI has notably evolved for the assessment of pulmonary vasculature. However, uncertainty persists about the performance of MRI for the diagnosis of acute pulmonary embolism (APE). OBJECTIVES: To clarify the comprehensive role of MRI for diagnosing APE. METHODS: Studies were identified through a search of Pubmed and Ovid databases. And QUADAS-2 tool was applied for quality assessment of the included studies. RESULTS: 15 studies on patient basis and 9 on vessel basis were retrieved. The patient-based analysis yielded an overall sensitivity of 0.75 (95% confidence interval 0.70-0.79) and 0.84 (0.80-0.87) for all patients and technically adequate patients, respectively; with an overall specificity of 0.80 (0.77-0.83) and 0.97 (0.96-0.98), and a pooled diagnostic odds ratio (DOR) of 51.07 (18.36-142.05) and 155.22 (86.83-277.47). A direct comparison of different MRI modalities showed that combined MRI test had the highest pooled DOR and the lowest proportion of inconclusive images. Of note, heterogeneity and moderate quality were observed. On vessel basis, MRI had high sensitivity and specificity in larger-order vessels, but a significantly lower sensitivity of 0.55 (0.50-0.60) for subsegmental APE. CONCLUSIONS: On patient-based level, MRI yields high diagnostic accuracies for the detection of APE, especially in technically adequate images. And the inconclusive MRI examinations virtually result from motion artifact and poor arterial opacification. Combined MRI test appears to be a more promising diagnostic tool with greater discrimination power over single techniques. From a vessel-based perspective, MRI exhibits high diagnostic capability with proximal arteries, while lacks sensitivity for peripheral embolism. This article is protected by copyright. All rights reserved