After several decades of development, magnetic resonance (MR) imaging has matured toward a valuable alternative to other guidance modalities like CT or ultrasound for image-guided biopsies. Due to the higher complexity and intervention costs, MR-guided biopsies are not a “first line” option; but may be performed in difficult cases where lesions are not visible using other imaging modalities, where extreme needle angulations are necessary, and in pediatric patients. In experienced hands, MR-guided biopsies yield results comparable to CT-guided interventions for lesions not amenable for CT- or ultrasound-guided biopsies.