Objective: To observe the clinical efficacy of butylphthalide injection combined with Xuesaitong Injection in the treatment of acute cerebral infarction, and to evaluate the efficacy from the perspective of MRI perfusion imaging. Methods: 80 patients with acute cerebral infarction who met the inclusion criteria were randomly divided into control group and treatment group according to the random number table method, 40 cases in each group. After admission, the patients in both groups were treated according to the clinical pathway, and were given drugs such as antihypertensive, hypoglycemic, lipidlowering, neurotrophic, and antiplatelet aggregation. The control group was treated with butylphthalide sodium chloride injection 100 mL intravenous drip on this basis, while the observation group was treated with Xuesaitong injection 200 mg and 5% glucose injection 250 mL intravenous drip on the basis of the control group. The National Institutes of Health Stroke Scale (NIHSS) score, Barthel Index (BI) of activities of daily living score and MRI perfusion imaging related indicators were compared between the two groups on the day of admission and 10 days after treatment. Results: The total effective rate of the treatment group was significantly higher than that of the control group (97.50% vs 77.50%, P<0.05); After treatment, the NIHSS score of the two groups decreased and the Bi score increased compared with that before treatment, and the difference was statistically significant (P<0.05), and the treatment group was better than the control group (P<0.05); After treatment, the attenuation index of the region of interest in both groups was significantly reduced, and the average diffusion coefficient was significantly increased (P<0.05), and the data of the treatment group were significantly better than those of the control group (P<0.05); After grouping treatment, the cerebral blood volume and cerebral blood flow of the treatment group were significantly better than those of the control group (P<0.05); According to Pearson correlation analysis, the average diffusion coefficient (r=-0.503, r=0.482), attenuation index (r=-0.487, r=0.414), cerebral blood volume (r=-0.527, r=0.402) and cerebral blood flow (r=-0.625, r=0.516) in the treatment group after treatment were significantly correlated with NIHSS score and Bi score (P<0.05). Conclusion: Based on the results of multimodal MRI imaging, it can confirm the good effect of butylphthalide injection combined with Xuesaitong Injection in the treatment of acute cerebral infarction, show the difference changes of average diffusion coefficient and attenuation index in the lesion area before and after treatment, intuitively reflect the changes of volume ratio anisotropy and partial anisotropy, as well as the improvement of cerebral blood flow and cerebral blood volume, and the changes of the above indicators have a good correlation with the degree of neurological deficit and the changes of daily living ability in patients with acute cerebral infarction, suggesting that the results of multimodal MRI imaging can provide a reliable reference for the evaluation of the curative effect of acute cerebral infarction.