In what situations do you obtain both a pelvic MRI and EUS for rectal cancer staging and treatment planning?

I'm not sure that T2N1 is boderline - preop CRT is still a standard of care for node positive disease.

Generally, thin slice (3mm or less) MRI with external (if available) or internal coil is the preferred staging modality for patients with newly diagnosed rectal cancer. Utilize the T2 images and contrast isn't necessary (but potentially helpful).

Advantages over transrectal EUS:

1) Much less operator dependent than EUS

2) You can see more of the nodal stations with MRI, compared to EUS.

3) You can pick up extramural venous involvement, which portends higher rate of distant metastases.

4) You can identify circumferential margin with high specificity

5) You can more accurately stage stenotic tumors (hard to pass EUS probe through these)

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