Abstract: Skeletal system lesions encompass a wide variety of pathologies with complex pathogenic mechanisms. Most scholars hold that the imbalance between water and fat proportions in bones constitutes a key factor contributing to their physiological and pathological changes, and also serves as the material basis for the occurrence of imaging alterations. Magnetic resonance imaging (MRI) is an important method for diagnosing such diseases, yet it is restricted by slow scanning speed, numerous contraindications, and high costs. It cannot achieve ideal diagnostic results in patients with metal implants in their bodies, those who are restless, those with claustrophobia, and especially in emergency patients.As an advanced imaging method, dual-energy CT virtual non-calcium (DECT-VNCa) technology, on the basis of ensuring high-resolution display of bones, not only can perfectly avoid these limitations but also can reach diagnostic efficacy similar to that of MRI, particularly in cases of bone marrow edema, infiltrative bone diseases, rheumatic immune arthritis, ischemic necrosis, and degenerative osteoarthropathy. The pseudo-color images generated through post-processing can quickly, clearly, and accurately determine the scope and nature of skeletal lesions, thereby opening up a new path for the diagnosis of skeletal system lesions.