Objective To study the diagnostic efficacy of 256row dualsource CT (DECT) in gouty arthritis (GA). Methods A total of 117 GA inpatients in the First Affiliated Hospital of Anhui University of Science and Technology from January 2019 to December 2020 were collected. 50 patients underwent GA with 256row DECT, and 30 patients with other types of arthritis who were hospitalized at the same time were compared as the control group. The area under ROC curve (AUC) was calculated to evaluate the diagnostic efficiency of DECT. The coincidence rate of DECT with HFUS, X-ray, CT and MRI was compared.Results There were significant differences in DECT findings of gout nodules and urate crystals between GA group and control group (P＜0.05). There was no significant difference in soft tissue swelling, joint effusion, bone destruction and synovial thickening (P＞0.05). There was significant difference between DECT and X-ray, MRI (P＜0.05). There was no significant difference between HFUS and HFUS (P＞0.05). Conclusion The 256 row DECT has a high diagnostic efficiency in GA diagnosis, and the diagnostic coincidence rate is significantly higher than that of X-ray and MRI. It has high specificity for gout nodules and urate crystals, and can be used in the diagnosis of GA in clinic.