Brain imaging plays a central role in the assessment of patients with acute ischemic stroke. Modern multimodal imaging protocols can provide comprehensive information about prognosis, management, and outcome of the disease, and may detect changes in the intracranial structures reflecting severity of the ischemic injury depicted by four Ps: parenchyma (of the brain), pipes (i.e., the cerebral blood vessels), penumbra, and permeability (of the blood brain barrier). In this article, we have reviewed the modern multimodal acute stroke imaging protocols in the light of the aforementioned four Ps.