In women diagnosed with cervical cancer, MRI may assist clinical staging and influence treatment selection. T2-weighted MR images provide contrast for the assessment of local tumor extent. However, no tumor characterization can be assessed. Fatty acids physically interact with cell membrane and have the potential to change their permeability, which may lead to depolarization and cell apoptosis[1]. Positive correlations between unsaturated lipids and risk of cancer has been published[2]. 14C glucose studies have also shown that fatty acids in tumor tissue come mainly from novo-synthesis[3] involving an increase in fatty acid metabolism[4]. In this work we wanted to assess the feasibility of imaging the fatty acid composition of tumor-free and tumorous cervical tissue using 1H MRSI at 7T and to investigate their differences.13 patients with histologically proven stage IB1 to IIB2 cervical cancer were scanned in a 7T MR system (Philips, Best, The Netherlands) after providing written informed consent. Seven transmit-receive fractionated dipole antennas[5] (MR Coils BV, Drunen, The Netherlands) were positioned around the pelvis and an additional receive only rectal antenna (Machnet BV, The Netherlands) was used during reception only to increase the signal to noise ratio. A multi-transmit system was used for B1+ shimming in the cervix. Amplitude and phase shimming was done to maximize the B1+ field and homogeneity in the cervix. After the routine protocol images, single voxel (STEAM, TE/TR=75ms/1400ms, 25x25x25mm voxel, 192 NSA and 16 phase cycles) and 2D MRSI was obtained (STEAM, TE/TR=36ms/1400ms, 16x16 matrix, 5x5x10mm voxels) from the area of the tumor or from tumor-free tissue. All scans used VAPOR with a 150 Hz bandwidth for water suppression.Using the simple but effective STEAM pre-localization scheme and B1+ shimming with 7 transmit elements, excellent spectroscopic maps could be obtained from the cervix. Not only levels of choline could be obtained (figure 1b), but also clear depiction of the lipid resonances. Particularly the ratio between the resonances of 2.1 ppm and 1.3 ppm that reflects the chain length of the lipid molecules are highly variable between tumor areas. The elevated fatty acid signals at 2.1 ppm are observed in cervical cancer patients (fig. 1 a, and b) that had cervical squamous cell carcinoma and adenocarcinoma (both with stage IB2) respectively. This in contrast to tumor free cervix (from a patient without visible tumor and a patient that had surgery) in figures 1 c, d where the signals at 2.1 ppm were below noise level. Tumor free cervix shows only detectable 1.3 ppm fatty acids. Figure 2 shows an example of fatty acids metabolic maps for a patient with adenocarcinoma. These maps show the 1.3 ppm fatty acids to be concentrated in close proximity to the cervical canal, which is surrounded by parametria, a fat bearing lymphoid tissue. The 2.1 ppm map shows relatively higher concentrations in tissue containing tumor only and coincides with an hyper-intensity area as seen in the MRI, which may indicate local necrosis.1H MRSI in cervical cancer patients is feasible at 7T and shows differences between tumor-free and tumor tissue. The shortened fatty acid chains in tumor compared to other tissue may contribute to the assessment of tumor necrosis.