2602 Fig. 6 a {1H}-31P MRSI spectrum and corresponding hepatic histology of a woman with alcoholic liver fibrosis. The biopsy shows extensive periportal and parasinusoidal fibrosis in addition to typical ballooning of hepatocytes. b { 1 H}-31P MRSI spectrum and corresponding hepatic histology of a man with cirrhosis of the liver. Biopsy shows micronodular alcoholic cirrhosis with typical pseudolobules. Compared with spectra of healthy controls and the patient with noncirrhotic liver disease increased PE/PC and, compared with hepatocellular carcinoma, increased GPE/GPC ratios can be observed. The position of the voxel observed is indicated in orthogonal slices (reproduced with permission from Schlemmer et al. [88]) fibrosis in chronic hepatitis C patients [100] indicate that Liver function (31P MRS) proton MRS, already a widespread method for quantifying liver fat content, will soon develop into a major line of Dynamic 31P MRS showed PME (fructose-1-phosphate) metabolic liver research. Natural abundance (i.e. 1.1%) increases and decreases in the levels of ATP and Pi in carbon-13 (13C) MRS demonstration of the presence of healthy volunteers in response to bolus fructose adminis- glycogen in the liver of a patient with glycogen storage tration, whereas in three adults with disorders of fructose disease suggests that MRS could replace liver biopsy in metabolism no spectral changes were seen, providing proof liver glycogen quantification [101]. Recently, others of fructokinase dysfunction [107]. In response to fructose showed correlations between fasting plasma glucose infusion, seven patients with nonalcoholic cirrhosis also level and both liver glycogen/glucose rate and liver showed reductions in the formation of PME and in the glycogen peak/fasting rate in diabetic patients, indicating utilisation of Pi, thus providing metabolic evidence that 13C MRS can be used for noninvasive measurement of confirming the expected impairment of liver function glycogen storage/degradation ability in the liver and can [108]. Infusion of glucose, alanine and ATP caused modest thus assist in tailor-made therapy for diabetes [102]. alterations in the levels of liver metabolites in cancer Another special feature is the use of fluorine-19 (19F) patients with cachexia [109–111]. In normal liver, dietary MRS as a means of quantifying 5-fluorouracil and related fish oil supplementation was shown to result in PDE metabolites in the liver and in focal disease under 5- increases, indicating that lipid metabolism is influenced by fluorouracil chemotherapy [103–106]. dietary intake [112].