Background Positive "dynamic spot sign" has been proven to be a potential risk factor for acute intracerebral hemorrhage (ICH) expansion, but local perfusion change has not been quantitatively investigated. Purpose To quantitatively evaluate perfusion changes at the ICH area using computed tomography perfusion (CTP) imaging. Material and Methods Fifty-three patients with spontaneous ICH were recruited. Unenhanced computed tomography (NCCT), CTP within 6 h, and follow-up NCCT were performed for 21 patients in the "spot sign"-positive group and 32 patients in the control group. Cerebral perfusion change was quantitatively measured on regional cerebral blood flow/regional cerebral blood volume (rCBF/rCBV) maps. Regions of interest (ROIs) were set at the "spot-sign" region and the whole hematoma area for "spot-sign"-positive cases, and at one of the highest values of three interested areas and the whole hematoma area for the control group. Hematoma expansion was determined by follow-up NCCT. Results For the "spot-sign"-positive group, the average rCBF (rCBV) values at the "spot-sign" region and the whole hematoma area were 21.34 +/- 15.24 mL/min/100 g (21.64 +/- 21.48 mL/100g) and 5.78 +/- 6.32 mL/min/100 g (6.07 +/- 5.45 mL/100g); for the control group, the average rCBF (rCBV) values at the interested area and whole hematoma area were 2.50 +/- 1.83 mL/min/100 g (3.13 +/- 1.96 mL/100g) and 3.02 +/- 1.80 mL/min/100 g (3.40 +/- 1.44 mL/100g), respectively. Average rCBF and rCBV values of the "spot-sign" region were significantly different from other regions (P < 0.001; P = 0.004). The average volumes of hematoma expansion in the "spot-sign"-positive and control groups were 25.24 +/- 19.38 mL and -0.41 +/- 1.34 mL, respectively. Conclusion The higher perfusion change at ICH on CTP images may reflect the contrast extravasation and be associated with the hematoma expansion.