BACKGROUND Chronic cerebral hypoperfusion (CCH) is a frequently encountered clinical condition that poses a diagnostic challenge due to its nonspecific symptoms. OBJECTIVE To enhance the diagnosis of CCH and non-CCH through Magnetic Resonance Imaging (MRI), offering support in clinical decision-making and recommendations to ultimately elevate diagnostic accuracy and optimize patient treatment outcomes. METHODS In the retrospective research, we collected 204 routine brain magnetic resonance imaging (MRI) from March 1 to September 10 2022, as training and testing cohorts. And a validation cohort with 108 samples was collected from November 14 2022 to August 4 2023. MRI sequences were processed to obtain T1-weighted (T1WI) and T2-weighted (T2WI) sequence images for each patient. We propose CCH-Network (CCHNet), an end-to-end deep learning model, integrating convolution and Transformer modules to capture local and global structural information. Our novel adversarial training method improves feature knowledge capture, enhancing both generalization ability and efficiency in predicting CCH risk. We assessed the classification performance of the proposed model CCHNet by comparing it with existing state-of-the-art deep learning algorithms, including ResNet34, DenseNet121, VGG16, Convnext, ViT, Coat, and TransFG. To better validate model performance, we compared the results of the proposed model with eight neurologists to evaluate their consistency. RESULTS CCHNet achieved an AUC of 91.6% (95% CI: 86.8-99.1), with an accuracy (ACC) of 85.0% (95% CI: 75.6-95.2). It demonstrated a sensitivity (SE) of 80.0% (95% CI: 71.6-95.6) and a specificity (SP) of 90.0% (95% CI: 82.3-97.8) in the testing cohort. In the validation cohort, the model demonstrated an AUC of 86.0% (95% CI: 80.3-93.0), an ACC of 84.2% (95% CI: 70.2-93.6), a SE of 83.3% (95% CI: 68.3-95.5), and a SP of 84.7% (95% CI: 70.3-96.8). CONCLUSIONS The model improved the diagnostic performance of MRI with high SE and SP, providing a promising method for the diagnosis of CCH.