Susceptibility mapping of deep gray matter in Wilson's disease: A systematic review and meta-analysis

Quantitative susceptibility mapping (QSM) enables assessment of brain metal deposition. This meta-analysis evaluated QSM alterations in Wilson's disease (WD). PubMed, Embase, and Web of Science were searched up to September 2025 for studies reporting QSM measurements in neurological or hepatic WD and healthy controls (HCs). Twelve studies were included (325 WD, 254 HCs). Neurological WD showed higher susceptibility than HCs in the caudate (mean difference [MD] = 33.92, 95% CI: 18.14-49.70, p < .001), putamen (MD = 48.42, 95% CI: 29.66-67.17, p < .001), globus pallidus (MD = 62.24, 95% CI: 39.74-84.73, p < .001), thalamus (MD = 15.15, 95% CI: 10.15-20.15, p < .001), red nucleus (MD = 30.25, 95% CI: 12.57-47.93, p < .001), and dentate nucleus (MD = 16.65, 95% CI: 2.52-30.78, p = .02). Compared with hepatic-onset WD, neurological presentations showed higher susceptibility in the caudate nucleus (MD = 23.45, 95% CI: 1.17-45.73, p = .04), putamen (MD = 43.20, 95% CI: 2.62-83.78, p = .04), and thalamus (MD = 11.11, 95% CI: 7.53-14.69, p < .001). Hepatic-onset WD showed milder increases versus HCs in the globus pallidus (MD = 18.13, 95% CI: 4.42-31.85, p = .01), red nucleus (MD = 16.87, 95% CI: 12.11-21.63, p < .001) and dentate nucleus (MD = 11.61, 95% CI: 8.28-14.95, p < .001). QSM reveals marked susceptibility elevations in neurological WD and mild changes in hepatic WD. TRIAL REGISTRATION: CRD420251232999, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251232999.