PURPOSE: To evaluate the effects of cardiac transplantation on the brain in patients with congestive heart failure (CHF), using quantitative 1H MR spectroscopy (1H-MRS). MATERIALS AND METHODS: Ten patients with CHF underwent MRI and quantitative1H -MRS before and 1 -2 and 4 -9 months after cardiac transplantation. MR spectra were obtained from parietal white matter (PWM) and occipital gray matter (OGM) using PROBE (PROton Brain Exam). Changes in MR signal intensity were evaluated, and the cerebral metabolic concentrations in PWM and OGM were compared. For comparative purposes, 20 normal Volunteers were included. RESULTS: No abnormal MR signal intensity was seen in the brain before or after cardiac transplantation. Changes in cerebral metabolic concentrations were observed on 1H-MRS; concentrations of creatine (Cr) in PWM, and of N-acetylacepartate (NAA), Cr and myo - Inositol(mI) in OGM were significantly lower before transplantation. After successful trans-plantation, Cr levels returned to their normal range in PWM and OGM, while a slightly increase choline (Cho) level was observed in PWM. CONCLUSION: Cerebral hypoperfusion in CHF can be evaluated using 1H-MRS. MRS may play a substantial role in monitoring the effect of cardiac transplantation.