None of the measured DECT-derived parameters were significantly different between normal and metastatic lymph nodes (LN). This finding suggests that the semi-quantitative measures obtained through DECT, do not provide sufficient distinction between normal and metastatic LNs. Consequently, these measures are inadequate for reliably identifying or characterizing suspicious LNs in clinical practice. Further studies may be necessary to explore alternative imaging techniques or additional biomarkers that could enhance the differentiation between normal and metastatic LNs, potentially improving diagnostic accuracy and patient outcomes in the management of HNSCC.