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Background Magnetic resonance imaging (MRI) is the first-line imaging modality for local staging of rectal cancer. The radiology report should deliver all relevant available imaging information to guide treatment. Purpose To explore and describe if there was a gap between the contents in MRI reports for primary staging of rectal cancer in Sweden in 2010 compared to evidence-based practice. Material and Methods A total of 243 primary MRI staging reports from 2010, collected from 10 hospitals in four healthcare regions in Sweden, were analyzed using content analysis with a deductive thematic coding scheme based on evidence-based practice. Focus was on: (i) most frequently reported findings; (ii) correlation to key prognostic findings; and (iii) identifying if any findings being reported were beyond the information defined in evidence-based practice. Results Most frequently reported findings were spread through the bowel wall or not, local lymph node description, tumor length, and distance of tumor from anal verge. These items accounted for 35% of the reporting content. Of all reported content, 86% correlated with the evidence-based practice. However, these included more information than was generally found in the reports. When adjusting for omitted information, 48% of the reported content were accounted for. Of the reported content, 20% correlated to key pathological prognostic findings. Six types of findings were reported beyond the evidence-based practice, representing 14% of the total reporting content. Conclusion There was a gap between everyday practice and evidence-based practice in 2010. This indicates a need for national harmonization and implementation of standardized structured reporting templates.