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The aim of this study was to assess the potential of noncontrast magnetic resonance imaging (NC-MRI) with diffusion-weighted imaging (DWI) in characterization of breast lesions in comparison to dynamic contrast-enhanced MRI (DCE-MRI) at 3 T.Consecutive patients with conventional imaging (mammography, ultrasound) BI-RADS 4/5 findings were included in this institutional review board–approved single-center study. All underwent 3 T breast MRI including readout-segmented DWI, DCE, and T2-weighted sequences. Final diagnosis was defined by histopathology or follow-up (>24 months). Two experienced radiologists (R1, R2) independently assigned lesion conspicuity (0 = minimal to 3 = excellent) and BI-RADS scores to NC-MRI (readout-segmented DWI including apparent diffusion coefficient maps) and DCE-MRI (DCE and T2-weighted). Receiver operating characteristics, κ statistics, and visual grading characteristics analysis were applied.Sixty-seven malignant and 56 benign lesions were identified in 113 patients (mean age, 54 ± 14 years). Areas under the receiver operating characteristics curves were similar: DCE-MRI: 0.901 (R1), 0.905 (R2); NC-MRI: 0.882 (R1), 0.854 (R2); P > 0.05, respectively. The κ agreement was 0.968 (DCE-MRI) and 0.893 (NC-MRI). Visual grading characteristics analysis revealed superior lesion conspicuity by DCE-MRI (0.661, P < 0.001).Diagnostic performance and interreader agreement of both NC-MRI and DCE-MRI is high, indicating a potential use of NC-MRI as an alternative to DCE-MRI. However, inferior lesion conspicuity and lower interreader agreement of NC-MRI need to be considered.