Objective: To evaluate the predictive efficacy of spectral CT quantitative parameters for central lymph node metastasis (CLNM) in preoperative clinical node-negative (cN0) papillary thyroid carcinoma (PTC) patients. Methods: Clinical and imaging data of 86 surgical pathologically confirmed PTC patients who underwent preoperative spectral CT imaging, were retrospectively collected. Differences in clinical and spectral CT features between the CLNM and non-CLNM groups were compared. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive performance of clinical features, spectral CT features, and a combined model, with area under the curve (AUC), sensitivity, and specificity calculated. Results: Among clinical indicators, sex, thyroglobulin (Tg) level, and cystic changes showed statistically significant differences between CLNM and non-CLNM groups (all P < 0.05). Among non-contrast (NC) spectral CT parameters, 40 keV_HU and 70 keV_HU values were significantly lower in CLNM group (all P < 0.05). Among arterial phase (AP) spectral CT parameters, all parameters except arterial normalized effective atomic number (NZ_eff) differed significantly between two groups (all P < 0.05). Among venous phase spectral CT parameters, 70 keV_HU value was significantly lower in CLNM group (P=0.014). Combined model demonstrated the highest predictive efficacy (AUC=0.896, sensitivity=86.7%, specificity=80.4% ), followed by spectral CT quantitative parameter model (AUC=0.835, sensitivity=73.3%, specificity=85.7% ), and clinical model (AUC=0.591, sensitivity=20.0%, specificity=98.2% ; all P < 0.05). Conclusion: Spectral CT quantitative parameters based on lesion characteristics improve the preoperative prediction of CLNM in cN0 PTC patients, and aid in treatment plan.