Structural abnormalities in gray matter, white matter, and cerebrospinal fluid in parkinson’s disease: a voxel-based morphometry study

Objective Parkinson’s disease (PD) is a neurodegenerative disorder affecting multiple brain systems, yet whole-brain structural changes remain incompletely characterized. We used voxel-based morphometry (VBM) to systematically quantify gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) volume alterations in PD and explore their potential clinical significance for deep brain stimulation (DBS).Methods High-resolution T1-weighted MRI scans were acquired from 200 PD patients and 176 age- and sex-matched healthy controls. VBM analysis was performed using SPM12/CAT12, with age, sex, and total intracranial volume as covariates. Statistical threshold was set at voxel-level p < 0.001, cluster-level family-wise error-corrected p < 0.05, with a cluster extent ≥ 100 voxels.Results Compared with controls, PD patients showed significant GM and WM volume reductions (both p < 0.001) and CSF volume increase (p < 0.001). GM atrophy was observed in the olfactory cortex, caudate nucleus, precentral gyrus, and supplementary motor area, while bilateral putamen and ventral posterolateral thalamus showed GM volume increase. WM atrophy was distributed in brain regions anatomically corresponding to key tracts of the sensorimotor network, default mode network, and dorsal attention network.Conclusion PD patients demonstrate global GM and WM atrophy with increased CSF volume, a bidirectional pattern of coexisting GM reduction and increase, and widespread WM atrophy across multiple functional networks, providing macrostructural imaging evidence for understanding PD clinical heterogeneity. The potential utility of these structural features for preoperative DBS assessment remains purely theoretical and requires prospective validation.