Detecting cervical lymph node (LN) metastases in primary head-neck squamous cell carcinoma (HNSCC) can be challenging, often requiring fine-needle aspiration (FNA) in suspicious LNs after initial (PET)-CT or MRI imaging. Not only is this an extra burden for the patient, but it also increases costs and delays the start of treatment for these fast-growing tumors. This pilot study aims to evaluate whether Dual-Energy CT (DECT)-derived parameters can differentiate between normal and pathological LNs in HNSCC, potentially eliminating the need for FNA.