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Preoperative staging with 18F-FDG PET/CT and its correlation with pelvic MRI and histopathological stage in rectal cancer patients was studied.Twenty-five patients with rectal adenocarcinoma were included (mean age 57.3; six females,19 males). Forpreoperative staging. all patients were scanned by pelvic MRI, abdominal CT or USG and PET/CT. The results were compared to reveal any additional benefit of PET/CT.After staging, six patients were sent for chemotherapy, nine for neoadjuvant treatment. 10 underwent operation, eight with low anterior and two with abdominoperineal resections. PET/CT in addition to other modalities changed thepreoperative TNM staging in 11 patients (44%). In 8/11, M and 3/11, N stages were changed. In nine of them, the stage was upgraded and in two downgraded. In one case, a lymph node thought to be metastatic was found to be innocent histopathologically, and in the other one a suspicious liver lesion thought to be metastasis initially was found later to be benign. In another patient a lymph node classified as benign by MRI was thought to be malignant by PET/CT. This lymph node wasproven by histopathology to be benign, i.e. a false positive by PET/CT.PET/CT scanning changed the stage in 11 and the treatment policy in eight out of 25 cases.