Background Stroke is a leading cause of disability, significantly affecting the brain’s white and gray matter. Neuroimaging techniques like Diffusion Tensor Imaging (DTI) and Voxel-Based Morphometry (VBM) offer valuable insights into these structural changes. Methods This study used Tract-Based Spatial Statistics (TBSS) to evaluate white matter integrity in stroke patients using DTI metrics, including Fractional Anisotropy (FA) and Mean Diffusivity (MD). VBM was employed to assess gray matter volume and cortical thickness. Correlation analyses were performed between imaging metrics and clinical scores, such as the NIH Stroke Scale (NIHSS) and Brunnstrom scores. Results TBSS analysis showed significant reductions in FA (globus pallidus: t = -4.71, p < 0.001; caudate nucleus: t = -4.20, p < 0.001) and increases in MD (globus pallidus: t = 3.96, p < 0.001; caudate nucleus: t = 3.85, p < 0.001) in stroke patients compared to controls. These changes correlated significantly with clinical outcomes; higher FA and lower MD were linked to better motor function (Brunnstrom score: r = 0.90, p < 0.001 for FA in globus pallidus) and lower stroke severity (NIHSS score: r = -0.91, p < 0.001 for FA in globus pallidus). VBM analysis revealed significant gray matter volume increases in the anterior cingulate cortex and six other regions at p < 0.001. Conclusion The study underscores the importance of white matter integrity in post-stroke recovery and highlights neuroplasticity in specific brain regions. Neuroimaging metrics like FA, MD, and gray matter volume are crucial for assessing stroke severity and guiding rehabilitation strategies.

The authors have declared that no competing interests exist.

The author(s) received no specific funding for this work.

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This study was approved by the ethics committee of Suzhou Hospital Affiliated to Nanjing University of Chinese Medicine

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