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find metastatic lesions. If suspicious areas are identified, CT andUS may be used to as an imaging guide to perform a needle biopsy.MRI is playing a larger role, particularly in the initial staging of rectalcancer. High resolution images of the MRI are used to determineif the cancer has invaded through the wall of the rectum into theadjacent perirectal fat and lymph nodes. This information is veryimportant for the cancer team, who will then decide if chemotherapyor radiation therapy is needed prior to any surgical procedure. All ofthe preoperative imaging and testing is to assure that the patient hasthe best odds of beating the cancer.After the initial staging and treatment, CT, PET, and ultrasoundare used to monitor the cancer. CT and PET can be used to see howwell the cancer is responding to chemotherapy and radiation therapyif metastatic lesions are present. They can also be used to periodicallyexamine the chest, abdomen and pelvis where most of the metastaticor recurrent lesions will be found if they develop. Ultrasound is usedprimarily to evaluate or follow masses in the liver. The surveillance ofthe patient allows the cancer team to diagnose and treat any problemsthat may arise.Paul Oberle, M.D.Diagnostic Radiology314-525-1145Paul Oberle, M.D.15