Background <p>Acute ischemic stroke is a leading cause of morbidity and mortality worldwide. Advanced neuroimaging techniques have significantly improved the diagnosis and management of ischemic stroke. Among these, susceptibility-weighted imaging (SWI) has gained attention for its ability to detect prominent vessel sign (PVS) in cerebral veins, which may reflect cerebral hypoperfusion and venous congestion. Despite its growing use, the diagnostic value of PVS in assessing stroke severity and predicting patient outcomes remains underexplored. The objective of this study was to evaluate the diagnostic value of PVS in acute ischemic stroke patients using SWI and its relevance to stroke severity and prognosis.</p> Methods <p>This study included 50 patients with acute ischemic stroke who underwent MRI with SWI sequences. The mean age was 60.34 ± 14.11&#xa0;years, with 52% being female and 48% male. Hypertension (56.0%) and diabetes mellitus (42.0%) were the most prevalent risk factors. The presence of prominent vessel signs (PVS) in SWI and large vessel occlusion (LVO) versus non-LVO cases were analyzed.</p> Results <p>PVS was detected in 70.0% of total patients with acute ischemic strokes using SWI, with 51.4% of LVO cases showing PVS compared to 31.4% in non-LVO and 17.1% in cases with no gross occlusion by time-of-flight magnetic resonance angiography (TOF-MRA) (<i>p</i> = 0.044). PVS was significantly more frequent in anterior circulation strokes (81.8%) compared to posterior circulation strokes (28.6%) (<i>p </i>= 0.004). These findings help in the assessment of stroke severity.</p> Conclusion <p>SWI is a valuable imaging tool for evaluating stroke-related changes, particularly in identifying prominent vessel signs and their association with large vessel occlusions and anterior circulation strokes. The findings highlight PVS utility in detecting vascular changes in acute ischemic strokes and further support its potential role in stroke classification and management strategies.</p>