Intracerebral hemorrhage is a devastating form of stroke. The overall incidence of spontaneous ICH worldwide is 24.6 per 100,000 person–years (1). Up to one third of patients with ICH experience hematoma growth in the first few hours after stroke onset. Accurate stratification of ICH expansion risk is crucial to identify those patients at highest risk of clinical deterioration because of active bleeding and therefore most likely to benefit from anti–expansion therapies.(2,3)The success of future interventions aimed at preventing hematoma expansion and subsequent poor outcome will likely depend on the accurate selection of patients at risk for hematoma expansion (4,5) The sensitivity of the spot sign in the prediction of substantial hematoma expansion with the use of single–phase CT angiography was 51% in the PREDICT study.(6).The primary aim of this study was to determine the accuracy of the spot sign in the prediction of hematoma expansion in patients with acute ICH by using standardized multiphase CT angiography. This technique enables the demonstration of additional time points from CT angiography by using the same injection of contrast material and very little additional radiation exposure (7)