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At the same time, PD and ET show overlapping features such as tremor-predominant phenotypes. These heterogeneities and overlaps pose challenges for clinical management and research and may indicate shared, transdiagnostic mechanisms of tremor. We hypothesized that MRI-derived volumetric differences relate to tremor phenotypes rather than diagnostic labels. We compared regional brain volumes among three patient groups with overlapping phenotypes but distinct diagnoses: ET, PD with tremor-dominant phenotype (PD-T), and PD with non-tremor-dominant phenotype (PD-nT). We studied 164 patients (18 ET, 38 PD-T, 108 PD-nT) who underwent structural MRI and standardized assessment of motor symptoms as candidates for deep brain stimulation. We compared regional brain volumes between groups. Volumes of the thalamus, pallidum, and pre-cerebellar and upper brainstem (midbrain, pons, superior cerebellar peduncle) differed across groups, being smallest in ET, intermediate in PD-T, and largest in PD-nT. Differences reached significance when comparing ET or PD-T with PD-nT but not ET with PD-T. Thalamic and brainstem volumes correlated with more severe and less levodopa-responsive tremor in PD. In contrast to the subcortical findings, cortical thickness was thinner in fronto-parietal regions in PD-nT compared to PD-T patients, with no difference relative to ET. We identified tremor-related volume loss in cerebellothalamic and interconnected regions (pallidum) in PD and ET. These findings, though preliminary, provide novel structural MRI evidence supporting shared mechanisms of tremor and point towards a transdiagnostic structural brain signature of tremor across PD and ET.<\/jats:p>","DOI":"10.1007\/s00702-025-03067-y","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T11:47:46Z","timestamp":1763725666000},"page":"1407-1419","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A transdiagnostic structural brain signature of Parkinsonian and Essential Tremor"],"prefix":"10.1007","volume":"133","author":[{"given":"Christian","family":"Ineichen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fraser","family":"Callaghan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heide","family":"Baumann-Vogel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"B\u00fcchele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth O\u2019Gorman","family":"Tuura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian R.","family":"Baumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5150-6066","authenticated-orcid":false,"given":"Simon J.","family":"Schreiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"issue":"3","key":"3067_CR1","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1212\/wnl.51.3.803","volume":"51","author":"A Antonini","year":"1998","unstructured":"Antonini A, Moeller JR, Nakamura T, Spetsieris P, Dhawan V, Eidelberg D (1998) The metabolic anatomy of tremor in parkinson\u2019s disease. 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