The main use of MRS is for the assessment of metabolism in vivo; that is because it has the unique ability to monitor metabolism noninvasively without the use of ionizing radiation. In recent years MRS has also become widely used for metabolomics, the science that aspires to monitor the metabolomethe totality of small-molecule metabolites in an organism, a cell or a disease. This chapter discusses the properties of MRS that make it suitable for metabolomic studies and the reasons why they are mainly performed ex vivo, as well as the methods used for preparing samples, performing the MRS and analyzing the resulting data. Further sections discuss MRS detection of metabolic aspects of the common cellular processes apoptosis, necrosis and autophagy. A final section summarizes metabolic studies of some diseases by MRS: cancer, cardiovascular disease, neurological and neurodegenerative diseases, and muscle disease.