In this article we review methods for the study of perfused cells, tissues, and organs using magnetic resonance spectroscopy (MRS). Biologically relevant nuclei and the different but often complementary information that they make available are presented. Pulse sequence implementation is discussed in the context of tailoring the desired metabolite information and suppressing unwanted resonances. Metabolites observable with MRS are generally limited to those present in relatively high (millimolar) concentrations. The importance of these metabolites and how flux through metabolic pathways can be observed using isotopic enhancement with 13 C is reviewed. Cell preparation and immobilization methods employing agarose threads, matrigel and alginate beads; and the use of porous and nonporous microcarriers, hollow fibers and bioreactors for perfused cell culture are discussed. Tissue preparation techniques for the study of perfused organs include the Langendorff heart, perfused liver, and lung preparations. Maintaining careful control of the perfusate composition, pH, oxygenation, and temperature all critically affect cell and organ viability as well as the measured levels of cell metabolites. The requisite apparatus for achieving this is reviewed. Perfusion model systems allow the acquisition of real-time kinetic metabolic information by MRS, providing unique insights into the effects of drugs and inhibitors on metabolite levels. They thus provide a valuable intermediate for translational research from cells to animals to humans and back again.