PURPOSE: To determine if patient age, chest radiographic abnormalities, or history of cardiopulmonary disease or venous thromboembolism affected diagnostic performance with ventilation-perfusion (V-P) imaging. MATERIALS AND METHODS: Receiver operating characteristic (ROC) analyses were performed on the final V-P imaging interpretation data obtained during the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study. Diagnostic performance with V-P imaging was measured as the area under the ROC curve. RESULTS: Overall diagnostic performance with V-P imaging was not substantially different in patients with varying ages, an abnormal chest radiograph, or a history of venous thromboembolism or cardiopulmonary disease. CONCLUSION: Because diagnostic performance with V-P imaging in detection of pulmonary embolism was similar among the patient populations examined, an abnormal chest radiograph or history of venous thromboembolism or cardiopulmonary disease does not appear to adversely affect overall diagnostic performance in evaluation of acute pulmonary embolism.