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To evaluate the clinical value of virtual monochromatic spectral (VMS) images with metal artifact reduction (MAR) algorithm in dual-energy computed tomography (DECT)-guided microcoil localization of pulmonary nodules.Fifty-one patients underwent DECT after placement of microcoils on small pulmonary nodules before video-assisted thoracoscopic surgery (VATS). Optimal energy level (in keV) was defined as the level at which CT values of nodules were equivalent to those of 120 kVp images and with no serious metal artifacts. VMS images at optimal keV and at 50, 90,110, and 140 keV with and without MAR were reconstructed. Image quality was scored using a 3-point scale: 1 = excellent, minimal artifacts; 2 = good, mild artifacts; and 3 = poor, extensive artifacts. Image quality scores between the VMS-only and VMS + MAR groups were compared;74 keV was found to be the optimal level for VMS images. The image quality of the VMS + MAR images at 74 keV were significantly better than VMS-only images (1.35 ± 0.59 vs 2.11 ± 0.87, P = .005). There was no difference in image quality score among VMS + MAR images at 74 keV and higher energy levels.VMS images from DECT at 74 keV with MAR can reduce artifacts from microcoils and improve image quality for microcoil localization of pulmonary nodules.