As imaging techniques have advanced from those that are based on tissue density and hence are strictly anatomical in nature, to include those based on physiologic and biochemical factors, the expectation has grown that imaging will be used to evaluate patients with diseases that are caused by disordered metabolism. In this review, recent advances in neuroimaging are discussed that have led to new insights into the pathophysiology of hepatic encephalopathy, a common condition that is caused by the failure of the liver to remove metabolic wastes from the blood.