Purpose: To assess the value of plain vs. iron oxide-enhanced MRI vs. the combined study (plain + postcontrast) based on qualitative and quantitative parameters of three pulse sequences. Materials and methods: Data from two sites were acquired using the same technique; therefore, this data could be pooled. T1W-SE, T2W-SE, and 3D-PSIF were used before and 24-36 hours after MRI with ultra small particles of iron oxide (USPIO) was performed. A total of 52 lymph nodes (LNs) in nine patients (25 benign, 27 malignant) were evaluated by two readers who were visually and quantitatively blinded to the histology. Combinations of the following diagnostic parameters were compared using logistic regression analysis: the diameter of the LN, the signal distribution of the LN on postcontrast agent MRI (homogeneous or heterogeneous), and qualitatively and quantitatively determined signal changes of the LN following administration of contrast agent in the three evaluated sequences. Results: Using pre- and postcontrast data, the optimized accuracy based on the statistically most significant parameters (LN diameter 10mm, visual and quantitativel assessment of signal change on T2W-SE) was 85% (82% sensitivity, 88% specificity). Precontrast data alone yielded 71% accuracy (67% sensitivity, 76% specificity). Postcontrast data alone yielded 67% accuracy (41% sensitivity, 96% specificity). Conclusion: Based on our results, USPIO-MRI improved the diagnosis of metastatic axillary LNs compared with precontrast MRI alone. Both pre- and postcontrast studies are needed. T1W-SE and T2W-PSIF did not yield significant additional information. This study may help to further improve the technique of USPIO imaging.