We investigated whether computed tomography (CT) perfusion can identify intracerebral hemorrhage patients at high risk of hematoma growth (HG). A total of 155 subjects underwent CT perfusion on admission. Variables associated with log-transformed absolute HG were explored with multivariable linear regression. Perihematomal cerebral blood volume (CBV) was inversely associated with HG (B = -0.20; p < 0.001), independently from blood pressure, hematoma volume, and other confounders. This association was not dose dependent, and only very low CBV (<1.4 ml/100 g) was significantly associated with HG (B = 0.25; p < 0.001). In conclusion, reduced perihematomal CBV is associated with HG, suggesting a potential role of the perihematomal region in the pathophysiology of hematoma enlargement. ANN NEUROL 2019.