Indication: The value of a supplementary HR breast MRI prior to percutaneous biopsy of suspicious pure microcalcifications is evaluated. Patients: In 95 patients with pure microcalcifications in the BIRADS 4 or 5 category in the mammogram, a HR breast MRI was also performed. All findings were clarified histologically. The results of the MRI were compared with the histological results. Results: In the total collective, 59 malignant findings were found, 42 of which were DCIS and 17 invasive carcinomas (NOS 15, ILC 1, MUC 1). The remaining 36 biopsies showed histological benign findings. The false positive rate for mammography was 38% and for MRI 15%. The MRI showed true-negative findings in 79% of cases. In these cases, a percutaneous biopsy could have been omitted. False-negative findings were present on MRI in 21% (7/33). These were exclusively intraductal carcinomas ranging in size from 0.4mm to 40mm, with an average of 9.1mm. An unremarkable MRI ruled out an invasive carcinoma. A relevant underestimation of findings was found in 16% of X-ray-guided biopsies and in 10% of MR-guided vacuum biopsies. Conclusions: The use of HR breast MRI in the presence of suspicious pure microcalcifications allows a reduction in unnecessary biopsies in almost 80% of cases without overlooking an invasive carcinoma. However, small intraductal carcinomas can be missed.