The spectrum of MR imaging-guided interventions includes biopsies, thermal ablation modalities, vascular applications, MR endoscopy and intraoperative MR imaging. The concept of MR guidance is based on the excellent morphologic and functional imaging achieved by MR. The most important recently published experimental and clinical results are discussed. In the future, MR imaging will play an important role in interventional radiology, minimal invasive therapy and guidance of surgical procedures.