Objective To study the application value of dual-source CT direct lower limb venous imaging in the diagnosis of lower limb venous obstructive lesions.Methods A total of 96 patients highly suspected of having lower limb deep vein thrombosis (DVT) who visited our hospital from June 2020 to May 2024 were selected for dual-source CT direct lower limb deep vein imaging (DSCTV) and Doppler ultrasound (DUS) examination. The diagnostic consistency between DSCTV and DUS was analyzed. Among them, 50 patients underwent lower extremity deep vein X-ray digital subtraction angiography (DSA) 3 days after above examinations. Using DSA as the gold standard, the diagnostic efficacy of DSCTV was evaluated. Results A total of 1,248 lower extremity vessels in 96 patients were examined. DSCTV detected 687 involved vessels, while DUS detected 648. The kappa value between DSCTV and DUS was 0.838, indicating excellent agreement. In the 50 patients who underwent DSA (650 vessels examined), DSCTV detected 318 blood involved vessels, and DSA detected 320. With DSA as the gold standard, the sensitivity, specificity, accuracy, positive and negative predictive values of DSCTV in diagnosing lower extremity DVT were 96.56%, 97.27%, 96.92%, 97.17%, and 96.69%. The kappa value was 0.938, indicating excellent agreement. Conclusion DSCTV demonstrates high diagnostic efficacy for lower extremity DVT and holds significant clinical practice