 Hi, everyone. Myself Dr. Uphal is in the department of radio diagnosis in Grand Medical College and JJ Group of Hospitals. I'm very thankful to my mentor Dr. Nagendra sir, assistant professor of our department. Today my topic is role of MRI in evaluation and staging of carcinoma rectum. Colorectal cancer is the third most common cancer in men and the second most common cancer in women in the world. Its prevalence is more in the developed countries than in developing countries. However, the mortality rate is lower in the developed countries due to increased screening, early diagnosis and improvement in staging of cancer. The prognosis of rectal cancer is related to tumor infiltration into the mesorectum and mesorectal fascia, ability to achieve negative circumferential dissection margins. MRI is used in local staging of tumor and aids in deciding the further plan of management. Total mesorectal excision is the standard treatment of rectal cancer. However, the use of neo-adjuvant chemotherapy in patients with locally advanced rectal cancers helps in better disease control. Ames and objectives. To evaluate the role of MRI with contrast in diagnosing the lesion and its extent, involvement of the peri-rectal areas, involvement of adjacent organs, nodal status and finally the local staging, restaging and recurrence. Materials and methods. Observational study was carried out in department of radio diagnosis at our institute. It was carried on 30 patients over a period of one year, referred from department of surgery. The scans were performed in 30 MR's immense machine using body coil. Inclusion criteria. The patients willing to participate in the study are included and the cases of all age groups. Exclusion criteria. The patients not willing to participate and having claustrophobia or any other contraindication related to MR. Age distribution. According to the distribution, according to age, less than 40 years old, only 13% of patients were diagnosed with rectal cancer. The most common age group with rectal cancer seems to be between 50 to 60 years. Common presenting symptoms. Common presenting symptoms are painless bleeding per rectum, streak of blood on stool, pain in abdomen with ulter bowel habits, tenors in complete evaporation, spurious diarrhea disease, however seen in ulcerative type of lesions, and pain with defecation, due to involvement of anal splinters, constitutional symptoms, anorexia, weight loss and malice. Distribution of patients according to symptoms. The majority of the patients, every alternate patients are supposed to have the complaints of bleeding per rectum and painful defecation. Pain in abdomen, ulter bowel habits are seen in less than 1% of patients. Coming to the staging of tumor, TNM classification of the rectal cancer is used in the reporting pattern. MRI is less useful in differentiating T1 and T2 kind of lesions. Subclassification of the T3 category is determined on the basis of MR evaluation and is used in European guidelines for treatment recommendations. M category is decided based on the number of nodes involved in the mesorectal fascia and the distant number of nodes involved. M category is done based on the PET CT or CECT. Coming to the cases discussion. A 64-year-old male patient came with cheap complaints of intermittent episodes of bleeding per rectum and pain in the perianal region with defecations in two years. There is involvement of the long segment for a length of approximately 6 cm in circling the wall. Thickening is seen in the involvement of the rectum. No means of rectal fascia or adjacent organ involvement is noted. Circumferential resection margins is negative. There is no evidence of extramural vascular invasion. No significant nodes are there coming. So it is staged under T3BN0. A 52nd case. A 55-year-old male patient came with cheap complaints of bleeding per rectum. Since 9 months, on colonoscopy, mass is felt in the rectum. MR imager shows an ill-defined irregular circumferential wall thickening of upper and mid-third of the rectum causing luminal damage. There is involvement of the mesorectal fascia but there are no significant mesorectal nodes. So it is classified as T3DN2A. A 47-year-old male patient came with cheap complaints of painless bleeding per rectum and incomplete evacuation of stools since 6 months. Patient lab results shows raised CEA levels. MR shows irregular circumferential wall thickening of the upper and mid-third of the rectum causing luminal damage. There is no involvement of extramural vascular invasion. Mesorectal fascia however is involved and the nodes are seen in the 5 o'clock position. So it is staged under T3DN2A. A 70-year-old male patient came with cheap complaints of bleeding per rectum, difficulty in passing stools, ulter bowel habits. Patient with cut exit on PR examination, hard irregular mass palpate in the rectum. MR shows short segments of circumferential wall thickening involving the mid and distal part of the rectum. Serozal irregularity is seen with mesorectal fat stranding suggestive of extra serozal spread. Anteriorly it is showing loss of fat planes with base of the bladder at the psychoprostatic junction. Mesorectal nodes are seen at 3 o'clock position they are more in number 70A so it is staged under T4AN2B. Anteriorly it is also showing loss of fat planes with the base of the bladder at the psychoprostatic junction. A 54-year-old male patient came with cheap complaints of bleeding per rectum since one year, feeling of mass per rectum since one month. A symmetric circumferential wall thickening is noted involving the lower and mid-thodes of the rectum. It is seen extending anteriorly involving the inferior and right lateral portion of posterior part of prostate and right seminal vesicles. Anti-abdominal screening of the same patient will be multiple T2 hyper-intensive lesions patterned throughout the liver like metastasis. So it is staged under T4BN1M1. Adenocarcinoma is diagnosed on biopsy. Conclusion. Tectal carcinoma is the cancer seen in elderly however the incidence of this disease is seen increasing in younger adults. Early screening and diagnosis is helping better outcome of the disease. MRA plays a major role in detecting the disease in early stages and defining the local regional spread of disease. Circumferential resection margin is the best predictor of local recurrence. If the tumor appears to be CRM positive, new adjuvant tumor therapy followed by surgery is preferred. A multidisciplinary team consisting of MRA radiologist, colorectal surgeon, medical and radiation oncologist and pathologist plays a crucial role in overall care in patients with rectal cancer. Thank you.