Sono brevemente descritti i meccanismi molecolari che controllano le trasduzioni energetiche cellulari e le basi biochimiche che permettono di valutare il grado di stabilità del metabolismo cerebrale. La determinazione quantitativa, con la spettroscopia RMN del fosforo, di: ATP, fosfocreatina, fosfato inorganico e pH citosolico permette di stabilire la capacità termodinamica dell'encefalo di rispondere a stress metabolici. Inoltre, la precisa conoscenza della concentrazione dell'ADP, regolatore della respirazione cellulare, della velocità di biosintesi dell'ATP e del Potenziale dei fosfati fornisce informazioni precoci circa lo stato di «pacchetto» dell'encefalo. Sono riportati diversi esempi di patologie encefaliche per le quali è stata dimostrata l'utilità della spettroscopia RMN: difetti genetici, emicrania, ipossia e asfissia perinatale, epilessia focale e generalizzata, conseguenze di un arresto cardiaco. Sono infine discusse la sensibilità e la specificità della spettroscopia RMN del fosforo.
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