BACKGROUND AND PURPOSE: Small intracerebral hemorrhage (ICH), defined as baseline NCCT hematoma volume (HV) <30 mL, is often considered lower risk for early expansion. We tested whether the edema-to-hematoma ratio (EHR) on baseline NCCT independently predicts expansion and whether combining EHR with HV enables practical bedside risk stratification. MATERIALS AND METHODS: We retrospectively analyzed 219 conservatively managed patients with small-volume ICH. Baseline NCCT underwent artificial intelligence–assisted 3D volumetry to quantify HV and perihematomal edema and to compute EHR. The primary outcome was binary early hematoma expansion on the first follow-up CT. Multivariable logistic regression included HV, EHR, age, deep location, intraventricular hemorrhage, and anticoagulation status. Discrimination and calibration were assessed with 5-fold cross-validation. Youden index cut-points were used to derive a simple bedside rule combining HV and EHR. RESULTS: Early expansion occurred in 20.1% (44/219). Lower EHR and larger HV independently predicted expansion. Per 0.10 increase in EHR, adjusted odds decreased by 23% (adjusted OR [aOR], 0.77; 95% CI, 0.66–0.88); per additional 5 mL in HV, odds increased by 37% (aOR, 1.37; 95% CI, 1.09–1.73). A bedside rule (HV ≥9.2 mL plus EHR ≤0.683) identified a high-risk phenotype with a 39.3% expansion rate vs 4.4% in the low-risk reference. The multivariable model outperformed either predictor alone (area under the curve, 0.748 vs 0.700 and 0.672) with acceptable calibration (intercept, −0.17; slope, 0.92; Brier score, 0.141). CONCLUSIONS: A lower baseline EHR independently predicts early expansion in small-volume ICH. Pairing EHR with HV yields a practical bedside rule with a large risk gradient and improves discrimination beyond volume alone, supporting targeted monitoring and timely repeat imaging. aOR : adjusted OR AI : artificial intelligence AUROC : area under the receiver operating characteristic curve EHR : edema-to-hematoma ratio HE : hematoma expansion HV : hematoma volume ICH : intracerebral hemorrhage IQR : interquartile range IVH : intraventricular hemorrhage PHE : perihematomal edema ROC : receiver operating characteristic