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Hepatic phosphorus magnetic resonance spectroscopy (31P MRS) offers the exciting potential of studying metabolic processes in the human liver in vivo. Many investigators have utilized 31P MRS to research a broad range of metabolic questions, and there is outstanding potential for this imaging modality in the future. However, at times it is difficult to appreciate this potential because most published series have been small, and comparisons between studies are difficult. Indeed, the published literature contains significant variation in data acquisition and data analysis techniques and, perhaps most importantly, the interpretation of the data itself. As MR technology continues to evolve and more studies are being performed, perhaps a greater consensus of study techniques and endpoints will emerge. This review summarizes the present literature on human hepatic 31P MRS.