Background <p>Previous studies have revealed brain structural deficits in patients with schizophrenia displaying predominant negative symptoms, but results remain inconsistent. The present study aimed to investigate patterns of cortical structure, including cortical thickness (CTh), grey matter volume (GMV) and surface area (SA) in schizophrenia with predominant negative symptoms and their correlations with clinical features.</p> Methods <p>Structural magnetic resonance imaging was performed on 68 patients with schizophrenia displaying predominant negative symptoms and 56 healthy controls (HCs). The FreeSurfer software was used to analyze the imaging data and the support vector machine (SVM) method was used for pattern classification.</p> Results <p>Compared to HCs, patients showed reduced SA in right insular, and reduced CTh in the right parstriangularis cortex, left fusiform cortex and left precentral cortex compared to HCs. No significant correlation was observed between abnormal cortical structure of the patients with clinical parameters. SVM revealed that the CTh in the fusiform cortex could distinguish patients from HCs with values above 0.6 for sensitivity, specificity and accuracy.</p> Conclusions <p>The abnormal cortical structure in frontotemporal and insula regions might reflect the inherent pathological processes of schizophrenia, which are independent of the severity of negative symptoms. The CTh in the fusiform cortex could serve as underlying imaging markers to discriminate patients with schizophrenia from HCs.</p> Trial registration <p>Registered with ChiCTR. (identifier ChiCTR2500097853, registered at February 26th, 2025)</p>