Background: Rectal cancer is one of the most common cancers worldwide and its incidence isrnreported to be increasing in resource-limited countries, probably due to the acquisition of a westernrnlifestyle. The preoperative radiological stage also has been suggested to be correlated with thernprognosis of colon cancer and helps in guiding specific treatments. However, informationrnregarding imaging of rectal cancer in Ethiopia is limited. The main aim of the study was to assessrnthe preoperative imaging staging of Rectal cancer and correlating with pathologic stage in TASH. rnMethod: Institutional based descriptive cross sectional study conducted at TASH Addis Ababa,rnEthiopia for the duration of 2018-2021. The Study was conducted among histologically provenrnrectal cancer patients at TASH and that have complete staging work up before treatment initiationrnduring the study period. Data was collected from the operation room logbook, Oncology centerrncancer registry logbook, patient medical records and PACS for the images. The data was checkedrnfor clarity and completeness. Computerized data analysis was conducted by using SPSS versionrn25 software.rn rnResults: A total of 247 rectal cancer patients were enrolled in the study among which males werern123 and females 124 with median age of patients at presentation of 44 years. The majority ofrnpatients (99.6%) presented late with advanced stages (stage II-IV). Lymph node and distantrnmetastasis at the time of diagnosis was recorded in 79.3% and 21% of cases, respectively. Liverrnwas the most common site of distant metastasis. The low rectum was the most frequent anatomicalrnsite involved and all were adenocarcinoma (100%) by histology. Mucinous and signet ringrncarcinomas accounted for 16 (6.5%) and 18 (7.3%) patients, respectively. Overall accuracy,rnsensitivity and specificity of MRI was better than MDCT in local staging of rectal cancer. rnConclusions: Rectal cancer is not uncommon in our country and shows a trend towards a relativernyoung age at diagnosis and the majority of patients present late with advanced stage. There is arnneed for screening of high-risk populations, early diagnosis and appropriate staging work up for arnpatient, which guides treatment options. Promoting the use of MRI for local staging than MDCTrnthat has high accuracy, sensitivity and specificity.