In the past �ew years, there have been multiple advances in magnetic resonance (MR) instrumentation, in vivo devices, real-time imaging sequences and interventional procedures with new therapies. More recently, interventionists have started to use minimally invasive image-guided procedures and local therapies, which reduce the pain �rom conventional surgery and increase drug e��ectiveness, respectively. Local therapy also reduces the systemic dose and eliminates the toxic side e��ects o� some drugs to other organs. The success o� MR-guided procedures depends on visualization o� the targets in 3D and precise deployment o� ablation catheters, local therapies and devices. MR contrast media provide a wealth o� tissue contrast and allows 3D and 4D image acquisitions. A�ter the development o� �ast imaging sequences, the clinical applications o� MR contrast media have been substantially expanded to include pre-during-and post-interventions. �rior to intervention, MR contrast media have the potential to localize and delineate pathologic tissues o� vital organs, such as the brain, heart, breast, kidney, prostate, liver and uterus. They also o��er other options such as labeling therapeutic agents or cells. During intervention, these agents have the capability to map blood vessels and enhance the contrast between the endovascular guidewire/catheters/devices, blood and tissues as well as direct therapies to the target. Furthermore, labeling therapeutic agents or cells aids in visualizing their delivery sites and tracking their tissue distribution. A�ter intervention, MR contrast media have been used �or assessing the efficacy of ablation and therapies. It should be noted that most image-guided procedures are under preclinical research and development. It can be concluded that MR contrast media have great value in preclinical and some clinical interventional procedures. Future applications o� MR contrast media in image-guided procedures depend on their sa�ety, tolerability, tissue speci�icity and e��ectiveness in demonstrating success o� the interventions and therapies.