Objective To investigate the correlation between prominent hypointense vessels sign （PHVS） on susceptibility-weighted imaging（ SWI） and early neurological deterioration（ END） in patients with acute middle cerebral artery（ MCA） infarction. Methods Patients with acute MCA cerebral infarction admitted to the stroke ward of our hospital from September 2017 to September 2020 with complete data were retrospectively collected. The location and number of PHVS were quantitatively recorded using the modified SWI-ASPECT score. The patients were divided into END group and non-END group according to whether END occurred within 7 days after admission， and the independent correlation between PHVS and END was analyzed. Results A total of 240 patients with acute MCA cerebral infarction were included， including 67 patients in the END group and 173 patients in the non-END group. Univariate analysis showed that the differences in positive rate of PHVS， hypertension， admission NIHSS score， main artery stenosis and peripheral blood neutrophil/ lymphocyte ratio（ NLR） between END group and non-END group were statistically significant（ P ＜ 0.05）. Multivariate logistic regression analysis showed that positive rate of PHVS（ OR=4.925， 95%CI：2.525-9.607）， NIHSS score at admission（ OR=1.182， 95%CI：1.059-1.319）， NLR（ OR=1.148， 95%CI：1.017-1.295）， severe stenosis of main artery（ OR=2.620， 95%CI：1.185-5.793） and occlusion（ OR=4.643， 95%CI：1.662-12.975） were the risk factors of end in patients with acute MCA cerebral infarction Independent risk factors. In the subgroup analysis of PHVS positive patients， the modified SWI-ASPECT score in END group was higher than that in non-end group， and the difference was statistically significant（ P＜0.05）. Conclusions PHVS shown by SWI indicates an increased risk of END in patients with acute MCA cerebral infarction， which should be paid attention to.