Objective To explore the predictive value of CT signs combined with clinicopathological features for single cN0 papillary thyroid microcarcinoma (PTMC) central lymph node metastasis (CLNM). Methods A retrospective analysis of the CT signs and clinicopathological characteristics of 115 cases of single cN0 PTMC confirmed by surgery and pathology was performed, and univariate and multivariate logistic regression analysis were used to analyze the relationship between the contact between tumor and thyroid edge, tumor calcification, tumor location, tumor diameter, age, gender, thyroglobulin level and CLNM. According to the different contact range between tumor and thyroid edge in CT signs, the patients were divided into three groups: <1/4 group, 1/4–<1/2 group and ≥1/2 group. The proportion of CLNM positive patients in different contact areas between tumor body and thyroid edge was analyzed by using χ2 test. Results Among 115 cases of single cN0 PTMC, there were 26 cases and 89 cases with CLNM positive and negative, respectively. Univariate analysis showed that contact between tumor body and thyroid edge, tumor diameter, age, and gender were associated with CLNM positive (P<0.05). Further multivariate logistic regression analysis showed that thyroid marginal contact, age <45 years old and male were associated with CLNM positive (P<0.05). The proportion of CLNM positive patients in different contact areas between tumor body and thyroid edge (between the three groups ) was statistically different (P<0.05). The pairwise comparison among the three groups showed that the proportion of CLNM positive patients were statistically different (P<0.0167 after correction). Conclusions Tumor body contact with thyroid edge, age <45 years and male were independent risk factors for CLNM in patients with single cN0 PTMC. The combination of multiple risk factors can further improve the preoperative evaluation level of CLNM in patients with PTMC. Excluding clinical characteristic factors, the wider the contact area between the tumor and the thyroid edge, the higher the risk of CLNM, which provides a reasonable basis for selective central lymph node dissection.