Objective <p>We evaluated <i>ex vivo</i> feasibility of ice-ball visualization during bone cryoablation using dual-energy computed tomography (DECT).</p> Materials and methods <p>This <i>ex vivo</i> study included three porcine cadavers on which cryoablation was performed on four vertebrae. Spectral DECT acquisitions were made at 0 and 10 min after ablation. Conventional images, virtual monoenergetic images (VMIs) at 50 keV, electron density (ED), effective atomic number (Z_eff) and virtual non-calcium (VNCa) images were generated. Two radiologists assessed visibility and delineation of the ice-ball using a 4-point Likert scale. Quantitative analyses were made on HU VMI, VNCa noted HU*, ED, and Z_eff in bone and adjacent tissues. Fused ED and VNCa images were assessed for each vertebra. For one pig, the fused ED and VNCa images were compared with post-ablation magnetic resonance imaging (MRI).</p> Results <p>For each pig, the ice-ball was visible in soft tissues on all spectral images except on Z_eff images. The best contour delineation was observed on ED images for soft tissues, whereas the ice-ball was detectable in bone only on VNCa images, with poorer but acceptable contour delineation. Significant (<i>p</i> ≤ 0.039; effect size (ES) ≥ 0.84) changes in HU and ED were observed for the adjacent soft tissue. For bone, significant (<i>p</i> ≤ 0.043; ES ≥ 0.073) changes were found of ED and HU* on VNCa. ED/VNCa fusion improved ice-ball delineation in bone, confirmed by comparison with MRI.</p> Conclusion <p>The fusion of spectral ED and VNCa images could show potential in improving the visualization of the ice-ball during bone cryoablation.</p> Relevance statement <p>Fusion of electron density and virtual non-calcium images enhances the ice-ball visualization in bone during spinal cryoablation.</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p>The lack of visibility of the ice-ball in the bone during cryoablation represents a limitation for the safety of adjacent structures at risk.</p> </ItemContent> <ItemContent> <p>In bone, the ice-ball was detectable only on virtual non-calcium (VNCa) images, but the quality of its contour delineation was poorer.</p> </ItemContent> <ItemContent> <p>Electron density and VNCa fusion images improved ice-ball visualization and delineation in bone, as confirmed by comparison with MRI.</p> </ItemContent> </UnorderedList></p> Graphical Abstract <p></p>