Quantitative Three-Dimensional Color Power Angiography Parameters Predict Response to Locally Injected Bleomycin in Infantile Hemangioma

<b>Background</b>: This study aimed to explore the key factors affecting the efficacy of local bleomycin injection by quantitatively analyzing the blood flow parameters of lesions before treatment using three-dimensional color power angiography to allow early prediction of the treatment response in patients with infantile hemangioma. <b>Methods</b>: The clinical data of children diagnosed with infantile hemangioma and treated with locally injected bleomycin at the Children's Hospital of Chongqing Medical University between February 2018 and October 2024 were retrospectively analyzed. The treatment efficacy grades of the included patients were determined. Baseline clinical information and the three-dimensional blood flow parameters (the vascularization index, flow index, and vascularization-flow index) were collected and compared with the treatment response. The predictive ability of the identified indicators was evaluated using receiver operating characteristic curves. <b>Results</b>: Of the 40 patients included in the study, 13, 16, 8, and 3 had treatment efficacy grade I, II, III, and IV lesions, respectively. There were no significant differences in age or lesion location, type, or volume before treatment among lesions of different treatment efficacy grades (<i>p</i> > 0.05). The vascularization index, flow index, and vascularization-flow index were significantly higher in grade I lesions than in those of the other three groups (<i>p</i> < 0.001, <i>p</i> = 0.008, and <i>p</i> = 0.003, respectively), and these indices decreased as the efficacy grade increased. The vascularization-flow index was identified as an independent predictor of treatment efficacy, with a sensitivity of 81.5%, a specificity of 84.6%, and an area under the receiver operating characteristic curve of 0.85 at the optimal cutoff value of 23.3. <b>Conclusions</b>: The vascularization-flow index can be used as an objective predictor of the response of infantile hemangioma to locally injected bleomycin. It is recommended that patients with a vascularization-flow index <23.3 receive locally injected bleomycin, and those with a vascularization-flow index ≥23.3 should receive an alternative treatment option.