Abstract: Objective: To investigate the diagnostic value of dual-energy computed tomography (DECT) for Stage IIA talar osteochondral injuries, with magnetic resonance imaging (MRI) as the reference standard. Methods: Thirty consecutive patients admitted to the orthopedics department of our hospital from January 2023 to December 2023, with long-term ankle pain and diagnosed with an osteochondral lesion of the talus through clinical and MRI examinations, were enrolled. DECT was performed on the patients within 24 hours after the MRI examination. Doctor A diagnosed and staged the 30 MRI images based on the modified MRI staging criteria by Hepple et al. Doctors B and C, independently and blindly, performed visual assessment and staging of the DECT images after post-processing to generate virtual non-calcium images. Doctor D quantitatively assessed images from the patients with a Stage IIA injury using the virtual non-calcium technique, based on the MRI results. With MRI as the reference standard, the qualitative assessments of DECT were statistically analyzed by Doctors B and C. Doctor D quantitatively assessed whether there was a statistical difference in CT attenuation values in the lesion area in patients with Stage IIA injuries compared with the controls. Results: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of DECT qualitative diagnosis by Doctors B and C were 84%, 91%, 89%, 83%, and 90% and 85%, 89%, 88%, 83%, and 91%, respectively (Kappa values of 0.771 and 0.758). The sensitivity and specificity of qualitative assessment of Stage IIA lesions by Doctors B and C were 85% and 94%, and 84% and 93%, respectively (Kappa values of 0.807 and 0.801). The quantitative diagnosis by Doctor D showed a statistical difference, with an optimal cutoff value of −21.85 HU (sensitivity and specificity: 92% and 98.9%). Conclusion: DECT and virtual non-calcium imaging techniques have significant diagnostic value for patients with Stage IIA talar osteochondral injuries.