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This study aimed to determine if diffusion-weighted imaging (DWI) can differentiate between benign and malignant lymph nodes in patients with head and neck cancer. A total of 55 patients with confirmed head and neck cancer and enlarged neck nodes were enrolled and evaluated by two radiologists using a workstation. Lymph nodes were analyzed using 3D regions of interest (ROIs) placed on T2-weighted images and compared to the corresponding DWI images. This study found that DWI and ADC values can be used to assess metastatic lymph nodes in the neck and that the sensitivity, specificity, and AUC of a narrower ROI for recognizing metastases were greater compared to the ADC value of the whole node. The study also found that the size of the ROI affects ADC values. The results suggest that DWI can accurately predict the status of cervical lymph nodes in patients with head and neck cancer and that it may be useful in diagnosing, determining the stage, developing a treatment plan, and monitoring these patients.