Magnetic resonance imaging (MRI) is increasingly being used in the diagnosis and management of cerebrovascular stroke and is sensitive and relatively specific in detecting changes that occur during and after strokes. Despite the practical issues in using magnetic resonance imaging (MRI) for acute stroke management, multimodal MRI provides useful information for accurate diagnosis of stroke, evaluation of the risks and benefits of thrombolysis, and prediction of outcomes. Thehigh sensitivity and specificity of diffusionweighted image (DWI) can help distinguish acute ischemic stroke from stroke–mimics.Multimodal neuroimaging is assuming an increasingly important role in the initial evaluation and management of acute stroke patients in parallel with the expansion of therapeutic options. Multimodal MRI can identify the type of stroke (ischemia or hemorrhage), severity and location of the lesion, the patency of the intracranial vessels, the degree of cerebral perfusion, and the presence and size of the ischemic penumbra. This information can be used to guide both acute and long–term treatment decisions for stroke patients.