BACKGROUND: About half of MCI patients experience semantic deficits, which may predict progression to Alzheimer's disease (AD). The neural basis of these deficits in MCI is not well understood. This study aimed to examine the relationship between semantic memory performance and cortical thickness in MCI patients. METHODS: Using FreeSurfer, T1-weighted MRI scans were analyzed from MCI patients with (MCIsem+) and without (MCIsem-) semantic deficits. Correlation analyses across all participants, including healthy controls, examined the link between semantic memory and cortical thickness, controlling for age and education. Group comparisons of cortical thickness were also conducted between MCIsem+ and MCIsem- groups. RESULTS: Significant correlations emerged between semantic memory performance and cortical thickness in the left medial temporal lobe, right temporal pole, and bilateral frontal regions-areas involved in central semantic and executive processes. Additionally, MCIsem + patients showed reduced cortical thickness in frontal, parietal, and occipital areas compared to MCIsem- patients. CONCLUSION: Semantic memory performance in MCI patients is associated with structural differences in regions supporting both central and executive aspects of semantic processing. Given that MCIsem + patients may face higher risk of AD progression, longitudinal studies should investigate these cortical markers' predictive value.