Breast magnetic resonance imaging (MRI) has been shown to date to be of value in the high-risk population. Challenges in interpretation are present. Maintaining a high volume of examinations in dedicated centers definitely impacts positively on experience in interpretation. MR-guided intervention is a necessity in all diagnostic centers where breast MRI is performed. Guidelines in interpretation should be used in conjunction with optimum technique and by combining kinetic and morphologic information with clinical history and conventional imaging (mammography and ultrasound) findings, a recommendation for management can be made with more assurance.