To update the 2012 ESGAR consensus guidelines on the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer.

Fourteen abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) participated in a consensus meeting, organised according to an adaptation of the RAND-UCLA Appropriateness Method. Two independent (non-voting) Chairs facilitated the meeting. 246 items were scored (comprising 229 items from the previous 2012 consensus and 17 additional items) and classified as ‘appropriate’ or ‘inappropriate’ (defined by ≥ 80 % consensus) or uncertain (defined by < 80 % consensus).

Consensus was reached for 226 (92 %) of items. From these recommendations regarding hardware, patient preparation, imaging sequences and acquisition, criteria for MR imaging evaluation and reporting structure were constructed. The main additions to the 2012 consensus include recommendations regarding use of diffusion-weighted imaging, criteria for nodal staging and a recommended structured report template.

These updated expert consensus recommendations should be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI.

• These guidelines present recommendations for staging and reporting of rectal cancer.

• The guidelines were constructed through consensus amongst 14 pelvic imaging experts.

• Consensus was reached by the experts for 92 % of the 246 items discussed.

• Practical guidelines for nodal staging are proposed.

• A structured reporting template is presented.