Background: Conventional brain MRI cannot always distinguish between different white matter lesions. Susceptibility weighted imaging (SWI) can detect a sign called central vein sign which is suggested to discriminate between multiple sclerosis and other white matter lesions thus increasing the accuracy of MRI in MS diagnosis. This study aimed to evaluate the role of MR susceptibility weighted imaging in differentiating MS from CSVD lesions. Results: The central vein sign (CVS) was found to have a premium diagnostic performance in diagnosis of MS with sensitivity 83.3%, specificity 70%, positive predictive value 80.6%, and negative predictive value 73.7%. When CVS positive lesions load was ≥ 44.24%, the specificity of CVS in diagnosing MS raised to 100%. Conclusion: Detection of the CVS on SWI can reliably discriminate between MS and CSVD.