OBJECTIVE: The aim of our study was to compare the overall accuracy of ultrasonography (US), with at least one sign positive (double contour, tophus, aggregates), and dual-energy CT in the diagnosis of gouty arthritis. METHODS: PubMed, Web of Science, EI, Elsevier, Wiley Online Library and Cochrane library were systematically searched for studies on the diagnostic performance of dual-energy CT (DECT) and ultrasound (US) from 2005 to February 2016. After study selection, data and quality assessment, the sensitivity (SEN), specificity (SPE), diagnostic odds rate (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and summary receiver operating contraction racteristic (SROC) curves were calculated. RESULTS: Eleven publications met our inclusion criteria. Of these, six studies were included in the dual-energy CT group, six studies in the US group, and one study compared dual-energy CT and US. The pooled SEN, SPE, DOR, PLR, NLR and SROC of US with at least one sign positive, were 93%, 73%, 37.94, 3.39, 0.11 and 92%, respectively; and of DECT the values were 88%, 85%, 38.70, 5.12, 0.16, 93% and respectively. CONCLUSION: Based on current evidence, both US and DECT can be used for diagnosis of gouty arthritis, but there are some differences between them regarding diagnostic sensitivity and specificity.