To explore and analyze the predictive value of simple spot sign, simple blend sign and spot signs combined with blend sign in patients with intracerebral hemorrhage treated with stereotactic minimally invasive surgery. Methods: A total of 196 consecutive patients with acute intracerebral hemorrhage hospitalized in the Department of Emergency Neurology, the Affiliated Hospital of Guizhou Medical University from January 2018 to August 2022, were continuously enrolled and retrospectively analyzed. Based on whether hematoma expansion had occurred, cases were divided into hematoma expansion and hematoma non-expansion group. All the patients were treated with stereotactic minimally invasive surgery. All the patients underwent head CT and CTA on admission. Imaging signs such as blend sign, spot sign and their combination were recorded. Head CT was reperformed 24 h after admission and after operation. The risk factors of hematoma expansion were analyzed by binary Logistic regression, and the predictive value of each imaging sign was analyzed by ROC curve. Results: Fifty-nine cases were enrolled in hematoma expansion group and 137 in hematoma non-expansion group. The proportion of blend signs combined with spot sign in hematoma expansion group was significantly higher than that in the hematoma non-expansion group (59.3% vs. 29.9%, P<0.001). Binary Logistic regression showed that the blend signs combined with spot sign was an independent risk factor for hematoma expansion (OR=2.582, 95%CI 1.308～5.094, P<0.05). ROC curve analysis showed that the combined sign was higher than the single blend sign (22.0% vs. 5.9% and 4.7%); with a sensitivity of 59.3%, a specificity of 70.1%, a positive predictive value of 46.1%, a negative predictive value of 80.0% and Youden index of 29.4%. Conclu? sion: Spot signs combined with blend sign could predict hematoma expansion in patients with intracerebral hemorrhage treated with stereotactic minimally invasive surgery.