PURPOSE: With the use of localized, water-suppressed in vivo 1H magnetic resonance spectroscopy (MRS), we evaluated the proton metabolic alterations in patients with chronic alcoholism and healthy normal controls. MATERIALS AND METHODS: Patients with chronic alcoholism (N=10) and normal control subjects (N=10) underwent MRS examinations using a stimulated echo acquisition mode (STEAM) pulse sequence with 2X2X2 cm3 volume of interest (VOI) in the left cerebellum and basal ganglia. Proton metabolite ratios relative to creatine (Cr) were obtained using a Marquart algorithm. RESULTS: The specific feature in patients with chronic alcoholism was a significant decrease of N-acetylaspartate (NAA)/Cr ratio in the left cerebellum, compared with normal controls. No clear correlation of other metabolite ratios such as choline (Cho)/Cr and inositols (Ins)/Cr was established. CONCLUSION: Our preliminary study suggests that the reduction of NAA/Cr ratio may indicate neuronal loss in patients with chronic alcoholism. Thus, in vivo 1H MRS may be a useful modality in the clinical evaluation of patients with chronic alcoholism based on the proton metabolite ratios.