Objective To explore the clinical value of magnetic resonance imaging (MRI) in detecting major depressive disorder(MDD) associated with somatic symptoms. Methods 127 MDD patients with somatic symptoms admitted to our hospital from December 2022 to September 2023 were selected and divided into group without somatic symptoms(group A, PHQ-15 ≥ 10) and group with somatic symptoms (group B, PHQ-15<5) and the patients’ number of group A and group B was 46 and 81 respectively. Meanwhile, 67 healthy examination patients were selected as the reference objects. Select The 3.0MRI scanner were used for scanning. The MR data were preprocessed using VBM8 software package to compare the volume differences in cerebral gray matter. Results PHQ-15 scores and HAMD- 24 scores varied significantly among the three groups (P<0.05). The PHQ-15 score of Group B was slightly different from the PHQ-15 score of Group A, but not significantly (P>0.05). VBM analysis between depression group and healthy control group showed that the volume of right inferior and left superior temporal gyrus in group A and group B decreased compared with the control group. The volume of the right middle temporal gyrus and left talar fissure in group A and group B increased compared with the control group. The number of voxels in the right inferior orbitofrontal gyrus in group B was significantly lower than that in group A (P<0.001). The number of voxels in right middle temporal gyrus and left talatus of group B with somatic symptoms increased significantly compared with group A (P<0.05). Conclusion Depression patients with somatic symptoms can find more changes in gray matter structure by MRI than those without somatic symptoms. These abnormalities in brain structures may be the neural basis for the development of various somatic symptoms in depressed patients.