Abstract: Objective: To investigate whether dual-energy CT post-processing techniques can enhance the accuracy of ASPECTS in patients with anterior circulation occlusion. Methods: A prospective study was conducted from October 2023 to January 2025. A total of 34 patients with anterior circulation occlusion (within 12 h) participated, with a total of 148 lesions (57 at the basal ganglia level and 91 in the cortical areas). Using DWI as the reference standard, an automated scoring software was used to evaluate post-processed DECT and conventional CT images. Sensitivity, specificity, accuracy, negative predictive value, positive predictive value, and 95% confidence intervals were calculated. Discrepancies between imaging modalities and DWI were statistically analyzed. Results: Conventional CT demonstrated uniform sensitivity (54% global, deep nuclear region and cortical regions), specificity (93%, 92%, and 93%), and accuracy (76%, 76%, and 75%). VNC showed higher sensitivity than NCCT (77%, 70%, and 81%) but lower specificity (68%, 70%, and 69%) and accuracy (73%, 71%, and 75%). Both 70 keV and 75 keV achieved comparable specificity to NCCT, with superior sensitivity (70 keV: 73%, 67%, and 77%; 75 keV: 68%, 67%, and 68%) and accuracy (70 keV: 82%, 80%, and 83%; 75 keV: 78%, 78%, and 78%). Compared with DWI, NCCT exhibited statistically significant differences in all regions. VNC showed significant discrepancies in global and cortical regions but not in deep nuclear regions. For 70 keV, significant differences were observed in global and deep nuclear regions, whereas no difference was indicated in cortical regions. Conversely, 75 keV demonstrated significant differences in global and cortical regions, while no statistical significance was indicated in deep nuclear regions. Conclusion: VNC exhibited higher false-positive rates. Among DECT post-processing techniques, 70 keV and 75 keV improved the accuracy of ASPECTS assessment in patients with anterior circulation occlusion as compared with conventional CT.