PURPOSE: To examine the usefulness of diffusion-weighted MRI (DW-MRI) for the detection of both primary colorectal cancer and regional lymph node metastases, and compare its performance with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in the same patients. MATERIALS AND METHODS: We studied 25 patients with known colorectal cancer. All underwent both DW-MRI and FDG-PET studies. The images were retrospectively assessed by visual inspection and the imaging findings were compared with histopathological findings on surgical specimens. RESULTS: Of the 27 primary colorectal lesions surgically excised in 25 patients, 23 (85.2%) were true-positive on both DW-MRI and FDG-PET. Two cancers were false-negative on DW-MRI but true-positive on FDG-PET, and two were false-negative on both DW-MRI and FDG-PET. With respect to the detectability of metastatic lymph nodes, DW-MRI and FDG-PET manifested a sensitivity of 80% (8/10) and 30.0% (3/10), a specificity of 76.9% (10/13) and 100% (13/13), and an accuracy of 78.3% (18/23) and 69.6% (16/23), respectively. CONCLUSION: DW-MRI is inferior to FDG-PET for the detection of primary lesions, but superior for the detection of lymph node metastases.