<p>Dual-energy CT (DECT) offers advantages over single-energy CT and MRI in the evaluation of the pediatric genitourinary system. Material specific techniques allow for creation of virtual noncontrast and iodine overlay images, which can avoid the radiation needed for a dedicated non-contrast CT or highlight areas of contrast enhancement. DECT also offers improved characterization of cysts and masses by differentiating between iodine, calcium, and proteinaceous/hemorrhagic material. Composition analysis of renal stones may allow for tailored stone therapy. Additionally, energy-specific techniques such as virtual monoenergetic images reconstructed at higher kV can reduce artifacts, especially those related to beam hardening. Conversely, virtual monoenergetic images reconstructed at lower kV offer increased contrast conspicuity, allowing for lower radiation and contrast doses. This paper reviews DECT technologies, post-processing techniques of material decomposition and virtual monoenergetic imaging, and examples of pediatric genitourinary clinical applications of DECT.</p>