To investigate whether atlas-based anatomical information can improve a fully automated lymph node detection system for pelvic MR lymphography (MRL) images of patients with prostate cancer.Their data set contained MRL images of 240 prostate cancer patients who had an MRL as part of their clinical work-up between January 2008 and April 2010, with ferumoxtran-10 as contrast agent. Each MRL consisted of at least a 3D T1-weighted sequence, a 3D T2*-weighted sequence, and a FLASH-3D sequence. The reference standard was created by two expert readers, reading in consensus, who annotated and interactively segmented the lymph nodes in all MRL studies. A total of 5089 lymph nodes were annotated. A fully automated computer-aided detection (CAD) system was developed to find lymph nodes in the MRL studies. The system incorporates voxel features based on image intensities, the Hessian matrix, and spatial position. After feature calculation, a GentleBoost-classifier in combination with local maxima detection was used to identify lymph node candidates. Multiatlas based anatomical information was added to the CAD system to assess whether this could improve performance. Using histogram analysis and free-receiver operating characteristic analysis, this was compared to a strategy where relative position features were used to encode anatomical information.Adding atlas-based anatomical information to the CAD system reduced false positive detections both visually and quantitatively. Median likelihood values of false positives decreased significantly in all annotated anatomical structures. The sensitivity increased from 53% to 70% at 10 false positives per lymph node.Adding anatomical information through atlas registration significantly improves an automated lymph node detection system for MRL images.