Most of the acute traumatic skeletal injuries are evaluated and treated on the basis of plain radiographs. Increased use of magnetic resonance imaging in investigation of acute musculoskeletal injuries during the last few years highlighted the value of recognition of the different bone marrow oedema patterns for more precise diagnosis of possible obscured soft tissue injuries. BME-like lesions in cases of traumatic injuries presented as focal bone marrow changes with decreased signal on T1W images and increased signal on T2W and STIR images; this appearance is thought to represent areas of haemorrhage, oedema or infarction secondary to trabecular microfractures. The osseous injuries may be the result of a direct blow or of compressive forces of adjacent bones impacting on one another. These injuries produce extensive BME. The indirect injury is the result of traction forces, which displays as avulsion injuries with localised BME. Sanders and Hayes in two different articles in "Radiographics" in the year 2000 identified distribution patterns of BME with different soft tissue and ligamentous injuries in the knee. Subsequently, the term "footprint" was introduced. In the knee, 5 different contusion patterns such as Saturday ing, especially for assessing lung and liver metastases. Despite inherent low tissue contrast, the excellent spatial resolution due to isotropic and multiplanar capacities has nowadays also improved the accuracy for local staging, provided that watery rectal enema is performed. Thanks to excellent tissue contrast, MRI has evolved as a powerful tool for regional staging, in particular to distinguish between T2 and T3 tumors and to assess the relationship of the tumour with the mesorectal fascia. The prerequisites are data acquisition in high-resolution mode and adequate slice positioning. However, perirectal desmoplastic reaction, inherent in rectal cancers, may mimic tumour infiltration, thus overestimating the T-stage. This drawback does not seem to change significantly with high-field MRI (3 T). For accurate lymph node staging, neither EUS, neither CT, nor MRI has proven excellent accuracy. Thus, alternative imaging modalities are steadily being evaluated, without any international consensus so far. Furthermore, state-of-the-art requirements and advantages of the most important recently developed imaging techniques, such as perfusion-CT, diffusion-MRI and USPIO-enhanced MRI for lymph node staging, as well as the indication for 18F-FDG PET/CT, will briefly be discussed. Patients identified at initial MRI staging as having locally advanced rectal cancer undergo neoadjuvant chemoradiation therapy (CRT) for their tumour to be downsized and downstaged, especially in low rectal cancers so that sphincter sparing surgery may be performed. In 15-30% of patients, complete pathological response is achieved. Reimaging with MRI at 6 weeks post-treatment is of great importance for assessing tumour response. However, referral depends greatly on the strategy that is to be followed by the surgeons in case of complete imaging response (no deviation from initial surgical plan, "wait and see" policy). Conventional MRI has a reported moderate accuracy for prediction of mesorectal fascia (MRF) involvement after CRT therapy, mainly due to its inability to differentiate between fibrosis with/ without the presence of tumour cells. Morphological MR imaging criteria that correspond to free of disease/ involved MRF have been reported, as well as criteria indicating disease being confined to the rectal wall (ypT0-T2). High-resolution MR images combined with radiologists' rising level of familiarity regarding the assessment of reactive changes post-CRT have increased local staging accuracy of MRI, including both T and N stage reporting. Introduction of imaging techniques such as diffusion weighted imaging, especially when combined with morphological T2w sequences and to a lesser degree PET/CT, for early and late tumour assessment response have shown promising results, especially when quantitative analysis is performed by means of post-CRT or % change of ADC values and SUV Response Index measurements. The increasing role of radiologists in the multidisciplinary management team of patients with rectal cancer is recognised and the role of MR imaging for stratifying these patients into a differentiated treatment is consolidated. Nowadays, with preoperative chemoradiotherapy (CRT), advanced rectal cancer shows phenomenal response with downstaging to small tumours (ypT0-2) confined to the wall. In 15-20%, no residual tumour is found in the resection specimen (complete response, ypT0N0). The paradigm shift in treatment has been further tailoring the treatment for the good responders after CRT, aiming at organ saving treatment options with less morbidity, such as local excision. Although still controversial, a wait-and-see policy (omission of surgery under close monitoring) is being advocated for the complete responders. This shift in treatment has consequences for radiologists.