Breast MRI is an emerging technology that may revolutionize our management of women with known or suspected breast cancer. MRI examinations should be interpreted with an awareness of the pitfalls and artifacts that can affect on image evaluation. Development of an MRI lexicon will assist by providing standardized terminology that may improve our understanding of the positive predictive value of different MRI features. To date, breast MRI has proven most useful in patients with proven breast cancer to assess for multifocal/multicentric disease, chest wall involvement, chemotherapy response, or tumor recurrence or to identify the primary site in patients with occult breast cancer. Further work is necessary to assess the utility of breast MRI in other settings, such as screening of women at high risk for breast cancer.