Computed tomography (CT) has evolved into a cornerstone of musculoskeletal tumor imaging, providing unparalleled spatial resolution and the ability to assess bone integrity, lesion mineralization, and local extension. Advancements like dual-energy imaging, spectral CT, and artificial intelligence (AI) have expanded CT’s role beyond anatomy to include function and quantification. CT is still particularly valuable in the assessment of bone tumors and tumor-like lesions due to its superior visualization of cortical bone, detection of subtle periosteal reactions, and characterization of lesion matrix components. Furthermore, CT is indispensable for surgical planning, biopsy guidance, and evaluation of treatment response or complications. Recent developments such as photon-counting detectors and AI-assisted image reconstruction are promising to further reduce radiation dose while enhancing image clarity and diagnostic specificity Additionally, dual-energy CT has opened new avenues in lesion tissue characterization by exploiting differences in atomic number and electron density, offering improved differentiation between benign and malignant lesions. This chapter provides an updated overview of CT techniques and clinical applications in the diagnosis and management of bone tumors and tumor-like lesions, reflecting technological advances and current best practices.