Clinical phosphorus-31 magnetic resonance spectroscopy (31P MRS) of the liver requires the use of whole-body magnets and of spectroscopy techniques that acquire signal from defined volumes-of-interest within the liver. Such localization techniques and recent clinical studies are briefly reviewed. These studies indicate that (1) high phosphomonoester levels are present in liver diseases involving structural damage, and (2) that MRS of liver tumors may provide a sensitive and rapid indication of response to cancer therapy. Abnormalities of the liver such as alcoholic liver disease, viral hepatitis, and metastasis were analyzed to determine hepatic acid/base status (pH) and to derive absolute molar concentrations of hepatic phosphorus metabolites rather than metabolite ratios. These parameters allow diagnosis and differentiation of several liver pathologies, suggesting an increasing future role of MRS in medical investigation, clinical diagnosis, and patient treatment.