Aim To explore the predictive value of CT blend sign and island sign combined with CT enhanced leakage sign in the early hematoma enlargement in patients with intracerebral hemorrhage(ICH). Methods Patients with blend sign and island sign hematoma enlargement risk factors in ICH baseline CT scan within 6 hours were scanned by CT enhanced arterial phase and delayed 3 min scan. The patients were divided into two groups according to the presence of leakage sign:leakage sign positive group and leakage sign negative group. The clinical data were collected and compared between groups, and the relationship with hematoma enlargement was analyzed. In addition, the influencing factors of early hematoma enlargement were analyzed by Logistic regression analysis, and the predictive value of early hematoma enlargement in ICH was evaluated.Results The admission GCS score of the group with positive leakage sign was significantly lower than that of the group with negative leakage sign(P＜0.05). The volume of hematoma in the group with positive leakage sign was significantly larger than that in the group with positive leakage sign. Logistic regression analysis showed that blend sign, island sign and leakage sign were the main risk factors for early hematoma enlargement. The sensitivity and specificity of blend sign and island sign combined with leakage sign in predicting early hematoma enlargement in acute ICH were 94.29% and 97.22%, respectively. Conclusion CT plain scan blend sign and island sign combined with CT enhanced leakage sign have high predictive value for early hematoma enlargement in ICH.