Detecting lymph node metastases is important but challenging in patients with pancreatic or periampullary carcinoma. USPIO-MRI is a promising tool to detect lymph node metastases. In 13 patients we detected on USPIO-MRI 86/307 suspect lymph nodes (28/78 regional and 58/229 distant). All patients with suspect regional lymph nodes had positive regional lymph nodes at histopathology. In evaluation of paraaortic lymph nodes discrimination between ganglions and lymph nodes showed to be important. Node-to-node analysis and follow-up of this study will give more accurate information on the value of USPIO-MRI for the detection of lymph node metastases in these patients.