Objective To explore the value of one-stop spectral CT scanning of computer tomography pulmonary angiography (CTPA) combined with abdominal-pelvic enhancement in preoperative evaluation for patients with gynecological tumors. Methods Ninety-six patients with gynecological tumors who received both spectral CTPA and abdominal-pelvic enhanced CT examination at Zhongshan Hospital (Xiamen Branch), Fudan University, between January 2022 and December 2023 were collected. The conventional scanning group (n＝48) received two independent spectral CT scans with twice contrast injections, while the one-stop scanning group (n＝48) received one-stop spectral CTPA and abdominal-pelvic enhancement with once contrast injection. Virtual monochromatic images (VMIs) at 65 keV for CTPA, 50 keV VMIs for abdominal-pelvic enhancement, contrast-enhanced iodine maps and effective atomic number images for the two parts were generated for all patients. The scanning parameters such as contrast agent dose, scanning duration, objective parameters of the images (CT values, iodine concentration, effective atomic number, etc.), as well as overall image quality score, the confidence score in diagnosing pulmonary embolization (PE), and the conspicuity of gynecological tumors were compared between the two groups. Results A total of 24 cases (25%) of PE were found in 96 patients. Compared with the conventional scanning group, the one-stop scanning group showed a significant reduction in contrast agent dosage ([62.88±3.59]mL vs [98.52±2.63] mL, P＜0.001) and scan duration ([95.94±0.38]s vs [108.91±0.35]s, P＜0.001). There was no statistically significant difference in dose length product (DLP), volume CT dose index, and effective dose (ED) between the two groups. There was no statistically significant difference in objective parameters and subjective image scores between the two groups of patients’ CTPA images, abdominal and pelvic CT plain scans, and enhanced images. All image scores were ≥3 points, meeting the diagnostic requirements. There was no statistically significant difference of confidence score in diagnosing PE and the ability to display tumor lesions between the two groups. Conclusions In comparison to conventional scanning, one-stop spectral scanning provides comparable image quality, confidence in diagnosing PE, and the conspicuity of gynecological tumors under a lower contrast agent dosage, a shorter scanning time, and a less patient waiting time in the preoperative evaluation for patients with gynecologic tumors, which is highly valuable.