Objective To evaluate the predictive performance of hematoma density heterogeneity scale (HDHS) to hematoma expansion (HE) in patients with spontaneous intracerebral hemorrhage (sICH).Methods Sixty-two patients with sICH,received therapy in our hospital form November 2011 to December 2014,were enrolled.HDHS scores were assessed on non-contrast CT (NCCT) image source,and HE progresses were assessed based on the follow up of NCCT at 24 h.Binary Logistic-regression analysis was used to determine independent risk factors of HE.Receiver operating characteristic (ROC) curve was adopted to identify the predictive performance of HDHS for HE.Results There were 37％ patients (23/62) in the cohort underwent HE.Binary Logistic-regression analysis showed that HDHS scores were independently associated with HE (OR=2.451,95％ CI:1.345-4.468,P=0.003).ROC curve analysis showed that the area under curve (AUC) was 0.745 (95％CI:0.625-0.865,P=0.001),the diagnostic critical value was 3,the sensitivity was 87％ and the specificity was 59％.Conclusion HDHS is an efficient tool that independently predict early HE in patients with sICH,and provides reliable evidence for prognosis and treatment.