LEARNING OBJECTIVES: Describe the basic principles and physics of the dual energy CT technique. Describe the limitation and artifacts related to dual energy CT. Discuss the utility of different Dual energy CT applications in imaging of the musculoskeletal system. BACKGROUND: Dual Energy CT, using different post processing techniques, has been an established valid tool for musculoskeletal imaging. Detection and analysis of gout has been already in the clinical use. Other DECT applications have been developed and have shown promising results including, but not limited to bone morrow oedema detection, infiltrative marrow lesions detection, evaluation of the intervertebral discs, ligaments and tendons, metal artifacts reduction and bone marrow density evaluation. CONCLUSION: Understanding the DECT physics and current DECT applications would help the radiologist detects relevant information and increase the diagnostic yield in the musculoskeletal imaging.