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The aim of this work is to investigate the structural MRI changes able to discriminate MSA phenotypes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The sample includes 31 MSA patients (15 MSA\u2010C and 16 MSA\u2010P) and 39 healthy controls. Participants underwent a comprehensive motor and neuropsychological battery. MRI data were\u00a0acquired with a 3T scanner (MAGNETOM Trio, Siemens, Germany). FreeSurfer was used to obtain volumetric and cortical thickness measures. A Support Vector Machine (SVM) algorithm was used to assess the classification between patients\u2019 group using cortical and subcortical structural data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After correction for multiple comparisons, MSA\u2010C patients had greater atrophy than MSA\u2010P in the left cerebellum, whereas MSA\u2010P showed reduced volume bilaterally in the pallidum and putamen. Using deep gray matter volume ratios and mean cortical thickness as features, the SVM algorithm provided a consistent classification between MSA\u2010C and MSA\u2010P patients (balanced accuracy 74.2%, specificity 75.0%, and sensitivity 73.3%). The cerebellum, putamen, thalamus, ventral diencephalon, pallidum, and caudate were the most contributing features to the classification decision (<jats:italic>z<\/jats:italic>\u00a0&gt;\u00a03.28; <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.05 [false discovery rate]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>MSA\u2010C and MSA\u2010P with similar disease severity and duration have a differential distribution of gray matter atrophy. Although cerebellar atrophy is a clear differentiator between groups, thalamic and basal ganglia structures are also relevant contributors to distinguishing MSA subtypes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jon.12927","type":"journal-article","created":{"date-parts":[[2021,9,10]],"date-time":"2021-09-10T16:16:07Z","timestamp":1631290567000},"page":"80-89","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Differentiation of multiple system atrophy subtypes by gray matter atrophy"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2833-4884","authenticated-orcid":false,"given":"Anna","family":"Campabadal","sequence":"first","affiliation":[{"name":"Medical Psychology Unit, Department of Medicine, Institute of Neuroscience University of Barcelona  Barcelona Spain"},{"name":"Institute of Biomedical Research August Pi i Sunyer (IDIBAPS)  Barcelona 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