OBJECTIVE. The purpose of our study was to compare the diagnostic accuracy of an ultrafast ECG-triggered black blood-prepared HASTE sequence with chest radiography for the detection of pulmonary nodules. SUBJECTS AND METHODS. Sixty-four patients with various primary malignancies who had undergone radiography and MDCT of the chest also underwent ECG-triggered black blood-prepared HASTE MRI of the lung. MR images and radiographs were interpreted separately. The number, location, and size of detected lesions were recorded, and each hemithorax was classified as affected or not affected on the basis of a grade reflecting the conspicuity of nodular involvement. Sensitivity, specificity, and positive and negative predictive values for the detection of pulmonary nodules with diameters of 5 mm or larger were determined, using MDCT findings as the standard of reference. Lesions with diameters smaller than 5 mm were not evaluated. Additional lesion-by-lesion comparisons between MDCT and MRI findings were performed. RESULTS. MDCT confirmed pulmonary lesions in 32 patients, whereas HASTE MRI revealed lesions in 30 patients and chest radiography, in 19 patients. MDCT revealed 226 nodules in 32 patients, whereas MRI HASTE revealed 227 lesions in 30 patients. Conspicuity scale-based sensitivity and specificity for chest radiography were 55.8% and 92.4%, respectively, whereas HASTE MRI had a sensitivity of 93.0% and a specificity of 96.2%. Positive and negative predictive values for chest radiography were 80% and 79.3%, respectively, and for HASTE MRI, 93.0% and 96.2%, respectively. The sensitivity of HASTE MRI increased with lesion size, ranging from 94.9% for nodules between 5 and 10 mm in diameter to 100% for lesions exceeding 3 cm in diameter. CONCLUSION. ECG-triggered black blood-prepared HASTE MRI is reliable for detecting pulmonary nodules exceeding 5 mm and has proven significantly more accurate than conventional chest radiography. The technique appears useful as an adjunct to MRI of the heart, great vessels, or chest, potentially increasing the diagnostic yield of MRI examinations.