The neuroimaging workup for patients with suspected acute ischemic stroke has advanced significantly over the past few decades. Evaluation is no longer limited to noncontrast computed tomography (CT), but now frequently also includes vascular and perfusion imaging. Although acute stroke imaging has made significant progress with the development of multimodal approaches, there are still many unanswered questions regarding their appropriate use in daily patient care. It is important for all physicians taking care of stroke patients to be familiar with current multimodal CT and magnetic resonance imaging (MRI) techniques, including their strengths, limitations, and their role in guiding therapy.