© 2019, Springer Science+Business Media, LLC, part of Springer Nature. Combined PET/MRI is a proposed imaging modality for rectal cancer, leveraging the advantages of MRI and 18F-fluorodeoxyglucose PET. Rectal cancer PET/MRI protocols typically include dedicated pelvis bed positions utilizing small field-of-view T2-weighted imaging. For staging of the primary tumor, PET/MRI can help delineate the extent of tumor better as well as the extent of tumor beyond the muscularis propria. PET uptake may help characterize small lymph nodes, and the use of hepatobiliary phase imaging can improve the detection of small hepatic metastases. The most beneficial aspect of PET/MRI may be in treatment response, although current data are limited on how to combine PET and MRI data in this setting. Limitations of PET/MRI include the inability to detect small pulmonary nodules and issues related to attenuation correction, although the development of new attenuation correction techniques may address this issue. Overall PET/MRI can improve the staging of rectal cancer, although this potential has yet to be fulfilled.