Objective To investigate the changes of MRI fluid-attenuated inversion recovery vascular hyperintensity (FVH) in patients with unilateral middle cerebral artery (MCA) chronic occlusion and its predictive effect on cerebral infarction. Methods A total of 121 patients with unilateral MCA chronic occlusion admitted to our hospital from January 2019 to January 2021 were used as the retrospective cohort study subjects. They were divided into two groups according to the presence or absence of FVH, 36 cases in the FVH group and 85 cases in the non-FVH group. The clinical data of the two groups were statistically analyzed and the receiver operating characteristic (ROC) curve was used to analyze the predictive effect of FVH on cerebral infarction.Results The incidence of cerebral infarction in FVH group (97.22%) was significantly higher than that in non FVH group (52.94%)(2= 4.130, P=0.0042), but there was no significant difference between them in basic clinical data such as gender, age and BMI (P＞0.05). Among the 121 patients with unilateral MCA chronic occlusion, 80 had cerebral infarction, accounting for 66.12%. The ASPECTs score of cerebral infarction patients was (3.13±0.75), and ASPECTs score of non-cerebral infarction patients was (1.68±0.70), and the difference was statistically significant (t=10.291, P＜0.001). ROC curve analysis showed that the ASPECTs score of FVH predicted the AUC of cerebral infarction in patients with unilateral MCA chronic occlusion was 0. 847 (P＜0.01). Conclusion The occurrence of FVH indicates abnormal progression of cerebral blood perfusion in patients with unilateral MCA chronic occlusion, and the risk of cerebral infarction increases. Its ASPECTs scores have moderate predictive value for patients with cerebral infarction