Significant hematoma expansion (HE) affects one-fifth of people within 24 hours after acute intracerebral hemorrhage (ICH) and its prevention is an appealing treatment target. Although the CT-Angiography spot sign predicts HE, only a minority of ICH patients receives contrast injection. Conversely, non-contrast CT (NCCT) is used to diagnose nearly all ICH, so NCCT markers represent a widely-available alternative for prediction of HE. However, different NCCT signs describe similar features, with lack of consensus on the optimal image acquisition protocol, assessment, terminology and diagnostic criteria. In this review we propose practical guidelines for detecting, interpreting and reporting NCCT predictors of HE. This article is protected by copyright. All rights reserved.