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T1-2 rectal cancer has a 5-10% risk for nodal metastasis. TME after local excision(LE) of T1-2 tumours is performed to minimise the risk for local recurrence(LR). Accurateprediction of N stage would make a TME after LE unnecessary. The study aimed to evaluate whether contrast-enhanced (CE) MRI can safely select patients with N0 status for follow up after LE.Forty patients with an early tumour after LE(36 pT1, 4 pT2) underwent CE-MRI to evaluate N stage and residual tumour. The contrast agent used included Ultrasmall-Superparamagnetic Particles of Iron-Oxide (USPIO;n = 26) or gadofosveset(n = 14). A pelvic MRI expert evaluated the scans. In the case of N0 status, patients were not operated but followed. Patients with N+ status underwent a TME.CE-MRIpredicted N0 status in 37 of 40 patients, who underwent follow up. Three patients had suspicious nodes. Two underwent surgery, confirming N+ status in one, but refuting N+ status in the other. The third patient underwent chemoradiation which sterilised the nodes. LR occurred in four patients (three luminal & one nodal). Two year LR-free survival was 94% and 2 year disease-free survival was 94% at a median follow up of 31(0-65) months.CE-MRI with lymph node-specific contrast agents is useful for selecting N0 patients eligible for follow up after LE for T1-2 tumours.