Low-flow vascular malformations are congenital lesions that can occur throughout the body. Treatment of these lesions is indicated to ameliorate pain, cosmetic disfigurement, and functional impairment. The first-line treatment of low-flow vascular malformations is percutaneous sclerotherapy. Traditionally, sclerotherapy is performed with a combination of ultrasound and fluoroscopy. However, malformations that are deep in the abdomen and pelvis or are obscured by overlying fascia or scar may be difficult to be visualized with ultrasound and fluoroscopy. MR-guided sclerotherapy has emerged as an alternative modality that can be used to needle guidance and sclerosant monitoring. In this review, we discuss the historical and current use of MR-guided sclerotherapy for the treatment of low-flow vascular malformations.