Objective: To investigate the feasibility of dual-energy CT in the evaluation of marrow edema of gouty arthritis. Methods: One hundred and sixty-one patients who had undergone plain dual-energy CT and diagnosed as gout between January 2017 and June 2018 were retrospectively analyzed. All examinations were performed on dual-source CT (Somaton Definition Flash, Siemens, Germany) with tube voltage of Sn140 kVp and 80 kVp. Then the images were transferred to Syngo. via (Siemens, Germany) postprocessing workstation for further analysis with 'marrow edema' module to diagnose marrow edema and acquire CT values on (double energy-virtual non-calcium, DE-VNC) images. MRI images of corresponding sites were also analyzed by the sequence of T1WI (T1 weighted imaging), T2WI (T2 weighted imaging) and STIR (short T1 inversion recovery). Results: After being analyzed by Syngo.via postprocessing workstation, it had been demonstrated that CT values between sites with marrow edema, sites adjacent to marrow edema and sites distant to marrow edema had significant differences (P<0.05). Based on the golden standard of MRI images, the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of dual-energy CT was 82.2%, 90.7%, 86% and 88.1%, respectively. Twelve missed cases was due to widespread bone destruction. Conclusions: Not only could dual-energy CT detect gouts, it also has good diagnostic accuracy in the evaluation of marrow edema of gouty arthritis. Cases with widespread bone destruction may be missed.