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Preoperative MRI of the liver and regular follow-up imaging revealed no synchronous or metachronous liver metastases in this cohort. Small hypo-attenuating indeterminate lesions of the liver are common in patients diagnosed with early rectal cancer and seem have no clinical significance. Additional pre-operative imaging or follow-up imaging for indeterminate liver lesions in these patients may be unnecessary. Small hypo-attenuating indeterminate lesions of the liver are common in patients diagnosed with early rectal cancer and seem hav