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Purpose: Small suspicious breast lesions that are only visible at MR imaging were preoperatively marked with a hook wire under MR-guidance to allow the removal of the lesion with tissue-sparing surgery. Method: In all patients the suspicious lesions were marked preoperatively under MR guidance with a hook wire using a commercially available stereotactic device. Interventions were performed with MR guidance on a 1.0 T and on a 1.5 T system. Results: In 19 patients 22 lesions were localized. One lesion was missed and removed in a second procedure. The mean duration for localization was 66{+-}20 min (range 38-119 min). In two patients two lesions were localized. The mean deviation of the wire tip to the lesion was 2,0{+-}2,6 mm. In this series, 6 of 22 lesions were malignant. The mean diameter of the lesion was 7.6{+-}2.6 mm (range 3-14 mm). Conclusion: Suspicious breast lesions detectable only in MR imaging can be accurately localized with a hook wire preoperatively under MR control to ...