Introduction: Colorectal cancer (CRC) is the 7th commonest cancer in Egypt, representing 3.5% of male and 3% of female cancers. About 40% of patients with CRC develop early recurrence within the first two years after completion of their treatment. Aim of the work: To evaluate the importance of 18F-FDG-PET/CT in detection of early relapse and to assess its effect on management in patients with CRC and equivocal CECT findings. Patients and Methods: Forty eight patients with treated colorectal cancer, under follow up were subjected to full clinical and laboratory assessment, CECT and PET/CT imaging plus histopathological examination of the biopsied sites of suspected recurrence.Results: Among 48 patients with CRC, PET/CT and histopathology were concordant in 41 patients (31 patients positive & 10 patients negative) and discordant in 7 patients (6 false positive & one false negative). Overall SN, SP, PPV, NPV and accuracy of PET/CT were 96.9%, 62.5%, 83.8%, 90.9% and 75.6% respectively. PET/CT and CECT findings exhibit significant association in detection of local recurrence, hepatic lesions, loco-regional LNs and distant lesions (p value 0.001, 0.001, 0.004 and 0.003 respectively). PET/CT led to overall changes in the therapy plan for 26/48 patients (54.2%), 12/48 patients (25%) from negative to be positive for recurrence and recommended for therapy.One patient (2.1%) from false positive to be negative and continue under follow up and 13/48 patients (27.1%) underwent modification in their plan either by addition or withdrawal of other therapy lines. 22/48 patients (45.8%) didn't show changes in their proposed plan. The changes in follow up, chemotherapy and radiofrequency strategies before and after PET/CT were significant (p value < 0.001, 0.004 & 0.038). Conclusions: PET/CT is efficient than CECT in detection of early CRC relapse. PET/CT has also a significant impact on directing management through improving the accuracy and decreasing the failure rate of the suggested therapy plan.