Background: Renal stones, also known as nephrolithiasis, are a common and increasingly prevalent condition with significant morbidity. The composition of renal stones, which can include calcium oxalate, uric acid, cystine, or struvite, plays a crucial role in determining the appropriate treatment strategy. Traditionally, the diagnosis of renal stone composition has relied on techniques such as stone analysis and metabolic testing; however, these methods can be invasive and time-consuming. Dual-energy computed tomography (DECT) has emerged as a promising non-invasive imaging modality capable of accurately identifying the composition of renal stones based on their attenuation properties at different energy levels. Objective: This study aims to evaluate the diagnostic performance of dual-energy CT (DECT) in identifying renal stone composition and to compare its accuracy with conventional imaging techniques in a case-control setting. The study also explores the potential clinical implications of DECT for guiding treatment decisions in renal stone management. Methods: A case-control study was conducted involving 150 patients with clinically diagnosed renal stones. Of these, 75 patients with known stone composition were included in the "control" group, while the remaining 75 had no previous stone analysis and were included in the "case" group. All patients underwent DECT imaging. Stone composition was assessed through DECT imaging and compared with the gold standard, which was the stone analysis post- surgery or post-passage. Sensitivity, specificity, and accuracy of DECT in detecting renal stone composition were calculated. Results: DECT showed a sensitivity of 92%, specificity of 89%, and an overall accuracy of 91% in determining the composition of renal stones. The accuracy varied based on stone composition, with calcium oxalate stones being the most accurately identified (96%), followed by uric acid (90%) and struvite stones (85%). DECT provided rapid results, facilitating the timely management of patients compared to traditional methods. Conclusion: Dual-energy CT demonstrates excellent accuracy in identifying renal stone composition and offers a non-invasive, rapid alternative to traditional methods such as stone analysis. It has the potential to improve the management of renal stones by aiding in the selection of the most appropriate treatment, whether medical or surgical, based on stone composition. Future studies are warranted to confirm these findings and evaluate the long-term clinical outcomes of DECT-guided treatment strategies.