〔Abstract〕 Objective To investigate the application value of IQon spectral computed tomography (CT) in the differential diagnosis of benign and malignant pulmonary nodules. Methods A total of 81 patients with pulmonary nodules admitted to the Second Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine from January 2021 to February 2023 were selected to undergo IQon spectral CT examination. Based on the results of pathological biopsy, the diagnostic value of IQon spectral CT in the differential diagnosis of benign and malignant pulmonary nodules was calculated, and the spectral CT parameters of benign and malignant pulmonary nodules were compared. Results According to pathological biopsy, 58 (71.60%) of 81 patients with pulmonary nodules were malignant and 23 (28.40%) were benign.The κ value of IQon spectral CT diagnosis of pulmonary nodules and pathological biopsy is 0.941, using pathological biopsy as the standard.The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of IQon spectral CT in the diagnosis of pulmonary nodule were 96.55%, 100.00%, 97.53%, 100.00% and 92.00% respectively.The venous atomic number (Zeff) and standardized atomic number (nZeff) of spectral CT parameters in patients with malignant pulmonary nodules were higher than those in patients with benign pulmonary nodules, and the difference was statistically significant (P < 0.05). Conclusion IQon spectral CT showed high diagnostic efficiency in the differential diagnosis of benign and malignant pulmonary nodules.