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Introduction: The presence of spotty lesions in ICH on T2, which we determined as a spotty sign, is occasionally observed. Our study was aimed to determine whether the presence of spotty sign on T2 could be an independent prognostic marker for hematoma expansion in ICH patients.Method: Patients with spontaneous ICH were retrospectively identified and their MRI images were reviewed. The spotty sign was defined as “the small lesions don’t matter the size and shape in the hematoma on MRI T2-weighted images”. Significant hematoma expansion was defined as an absolute increase of hematoma volume of >6.0mL or an increase in hematoma volume of >33%. Neurological severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) scores at admission. Univariate and multivariable logistic regression analyses were applied to assess the presence of the spotty sign and its association with hematoma expansion.Results: A total of 145 patients were enrolled, and 20 (14%) showed hematoma expansion, and 58(40%) had T2 spotty sign (Figure). Patients with hematoma expansion had a significantly larger hematoma volume (11.74ml vs 6.07ml, P<0.031), higher NIHSS score at admission (13 vs 7, P=0.002), and at discharge (8 vs 4, P=0.001) than those without expansion. Further, they had a higher yes findings rate of T2 spotty sign (65% vs 35%, P=0.002). Multivariate logistic regression analysis demonstrated that the spotty sign was an independent predictor of hematoma expansion (odds ratio [OR], 3.374; 95% confidence interval [CI], 1.110-10.256; P=0.032).Conclusion: The presence of a spotty sign on the initial MRI T2 scan should be associated with hematoma expansion in ICH patients.