Patients with chronic subcortical stroke undergo regional and network morphometric reorganizations beyond the lesion site, but the interplay between network and regional reorganization remains poorly understood. We aimed to clarify the reorganization patterns of the individualized differential structural covariance networks (IDSCN) in chronic subcortical stroke and investigate their associations with regional gray matter volume (GMV) changes and functional recovery. Structural MRI from four datasets enrolled 112 patients with chronic subcortical stroke (81 male, age: 55.82 ± 7.79) and 122 matched healthy controls (HC) (74 male
age: 55.28 ± 7.54). Network-based statistics were employed to identify aberrant IDSCN, Spearman correlation was conducted to assess the association between IDSCN and regional GMV alterations, and partial correlation was utilized to investigate the association between abnormal IDSCN and functional recovery. We identified 133 connections with balanced increased and decreased IDSCN. Aberrant IDSCN involved more regions than local GMV alterations, local GMV alteration exhibited intricate correlations with IDSCN, which could explain partly IDSCN reorganization (p <
0.05, corrected). Finally, abnormal IDSCN showed a weak association with long-term clinical recovery (p <
0.01). These findings reinforce the theory of adaptive network reorganization post-stroke and suggest that IDSCN may provide further insights into cortical reorganization and functional rehabilitation beyond regional morphometric measures.