PURPOSE: To assess the spectral alteration of phosphorus metabolities in patients with liver cirrhosis andcompare energy metabolites with clinical grades using 31P MR spectra localized by two-dimensional chemical shiftimaging. MATERIALS AND METHODS: In 15 normal (control) subjects and 12 patients with liver cirrhosis, 31P MRspectroscopy was undertaken. Patients were divided into two groups, namely 'mild cirrhosis' (Child A, n=5) and'severe cirrhosis' (Child B and C, n=7) according to disease severity, as assessed by Child-Hugh's classification.In vivo 31P MR spectroscopy was performed on a 1.5-T system (Magnetom Vision; Erlangen, Germany), using a surfacecoil. Peak areas of phosphomonoester (PME), inorganic phosphate (Pi), phosphodiester (PDE), and gamma-, alpha- andbeta-ATP were defined. Peak areas of phosphorous metabolites in the spectra were expressed as values of PME/beta-ATP,PDE/beta-ATP, PME/ATP, and PME/PDE. RESULTS: The values of PME/beta-ATP, PDE/beta-ATP, PME/ATP, and PME/PDE betweencontrol subjects and patients with liver cirrhosis were significantly different. With impaired hepaticdysfunction, PME increased as PDE decreased. In patients with severe cirrhosis, the values of PME/(-ATP andPME/ATP were significantly higher than those of patients with mild cirrhosis. CONCLUSION: In patients with livercirrhosis, peak areas of PME, were significantly higher, and this might reflect the severity of hepaticdysfunction. PME/(-ATP and PME/ATP valves appear predict the severity of cirrhosis.