Minimally invasive thermotherapies for focal tissue destruction on the basis of laser-, microwave-, focused ultrasound-, or cryogen-induced changes of tissue temperature represent an alternative to surgical tissue ablation, particularly in the treatment of tumors. The thermotherapy modalities listed necessitate indirect guidance and monitoring, since they often do not lend themselves to immediate visual control. In the brain, in head and neck tumors, in the liver, and in the prostate, MRI reliably and accurately delineates both the positions of interstitial thermotherapy applicators and--in contrast-enhanced, T1-weighted images--the perfusion defects in tissue necrosis induced by thermotherapy. The transfer of results of in-vitro and in-vivo model studies to assess interstitial temperature and lesion development during thermotherapy to the actual treatment of patients, however, is still in an initial phase. Further development of both rapid MRI sequences and MRI scanners suited for interventions will show how far treatment systems and guidance systems can be adapted to one another.