Objective: To analyse the imaging and clinical prognostic indicators for early hematoma enlargement after spontaneous intracerebral hemorrhage (ICH). Methods: In 126 patients, spontaneous ICH was diagnosed by computed tomography (CT) within 4 hours of disease onset. Repeat CT was performed after 24 hours to detect the development of hematoma enlargement. A regression equation was obtained by first examining the significance of correlations between possible risk factors and early hematoma progression, followed by verification using multivariate stepwise regression. Results: The incidence of early hematoma enlargement after spontaneous ICH was 25.4%, and the significant prognostic indicators were CT hematoma inhomogeneity, degree of consciousness impairment on admission and time between disease onset and initial CT. In addition, the characteristic 'hematoma enlargement border' on CT has important prognostic value in early hematoma enlargement. Conclusion: Clear prognostic indicators exist for early hematoma enlargement after spontaneous ICH, suggesting that hematoma inhomogeneity has important implications for predicting ICH progression, and we discovered as well as defined the 'hematoma enlargement border', an imaging characteristic of early hematoma enlargement. [Neurol Res 2009; 31: 362-366]