As a crucial intervention for stroke rehabilitation, acupuncture therapy has demonstrated definite efficacy and been widely used in clinical practice. However, its specific mechanisms in brain protection remain imcompletely elucidated, which limits the standardization and popularization of acupuncture therapy. In recent years, the rapid advancement of neuroimaging technologies has provided a new visualized perspective for deciphering the mechanisms underlying acupuncture-induced post-stroke brain protection, gradually revealing its multi-dimensional regulatory effects on brain networks, metabolism, and structure. Based on studies of acupuncture in stroke using multimodal neuroimaging techniques, this article summarizes key findings regarding acupuncture's roles in regulating cerebral metabolism, promoting structural remodeling of white matter and gray matter, and optimizing cerebral functional reorganization. It clarifies that acupuncture exerts neuroprotective effects through multiple mechanisms such as cross-network regulation, metabolic modulation, and structural remodeling. Additionally,the article points out the challenges faced in current research in terms of methodology, technology, mechanism, and translation, as well as proposes potential future directions. The aim is to provide references for the modern application of acupuncture in stroke treatment.