Background <p>Deuterium metabolic imaging (DMI) has recently been established as a versatile MR-based technique for in vivo mapping of glucose and other metabolic pathways using safe, non-ionizing ²H-labeled tracers.</p> Objective <p>In this review, methodological advances in DMI over the past decade are summarized, spanning hardware, acquisition, reconstruction, and quantification.</p> Approach and Outline <p>Developments in multinuclear system modifications and dual-tuned head and body coils that enable 3D DMI at clinical and ultra-high field strengths are outlined. Efficient spatial–spectral encoding strategies and balanced steady-state-free-precession-based MRSI, which improve SNR efficiency and spatiotemporal resolution, are reviewed together with temporally interleaved ¹H/²H acquisitions that integrate DMI into standard MRI workflows. Indirect ¹H-observed deuterium detection (QELT) is described as a complementary approach for sites without multinuclear hardware. On the reconstruction side, model-based, low-rank and AI-driven methods are highlighted for de-noising, accelerated sampling, and robust spectral–temporal fitting.</p> Outlook <p>Current strategies for concentration estimation, kinetic modeling, and treatment of label loss are discussed, positioning DMI as a promising complement to FDG-PET and ¹³C-MRS for studying metabolism in neurological, oncological and systemic disease.</p>