We evaluated the CT imaging signs which could predict hematoma expansion of intracerebral hemorrhage (ICH) patients and analyzed the correlation between them and apolipoprotein E (ApoE) gene polymorphisms. We aim to explore the role of the ApoE gene in the development of ICH. Methods: We recruited patients diagnosed with acute ICH who were also genotyped for the ApoE gene in the Department of Neurology in our hospital from June 2018 to April 2020 and collected their clinical and imaging data. We evaluated the imaging data and performed the chi-square test and logistic regression analysis to examine the correlation between the CT imaging signs and the ApoE gene. Results: Our study found that the CT black hole sign within 12 hours and 18 hours of ICH onset was associated with the ?2 allele carrier (P=0.009, P=0.030). Heterogeneous density of the hematoma within 24 hours of onset was correlated with the ?4 allele carrier (P=0.009). Logistic regression analysis showed that, within 12 and 18 hours of onset, the ?2 allele carrier was an independent predictor of the black hole sign; within 24 hours, the ?4 allele carrier was an independent predictor of heterogeneous density of the hematoma. Conclu? sion: Different alleles of ApoE may be involved in hematoma enlargement, and ApoE gene detection is significant for the diagnosis and treatment of patients with ICH.