Abstract
Status epilepticus (SE) is a neurological emergency with high morbidity and mortality. Early prognostication remains challenging, particularly in intensive care settings where clinical evaluations are limited. We investigated whether the voxel-wise proportion of preserved diffusion on diffusion-weighted imaging (DWI)—defined as the percentage of brain voxels with apparent diffusion coefficient (ADC) values between 600 and 1300 × 10⁻⁶ mm²/s—may represent a potential imaging marker associated with clinical outcomes that warrants further validation. We retrospectively analyzed 59 patients with SE who underwent DWI and electroencephalography within 72 h of seizure onset. ADC quantification was performed using a fully automated, segmentation-free pipeline. Patients were stratified by tertiles and dichotomized using a receiver operating characteristic (ROC)-derived threshold. The primary outcome was defined as a good outcome, corresponding to no change or improvement of at least one point on the modified Rankin Scale from premorbid baseline to hospital discharge. Patients in the highest ADC tertile had significantly better outcomes (odds ratio [OR] 5.67, p = 0.024). At the optimal threshold of 0.797, preserved ADC was associated with favorable outcomes after adjustment for clinical variables (OR 6.05, p = 0.045), along with younger age and lower EEG severity. A combined clinical–ADC model achieved an area under the ROC curve of 0.868. The preserved ADC was associated with improved outcome prediction and may provide exploratory imaging information for early risk assessment in patients with SE.
Data availability
The data that supports the findings of this study are available from the corresponding author upon reasonable request.
Code availability
The computational framework of this study, comprising the R scripts for voxel-wise modeling and anonymized datasets necessary for replication, is publicly available via GitHub [https://github.com/g2skhome/voxel-adc-se-prognosis]. While raw neuroimaging DICOMs remain restricted to uphold institutional patient privacy, the shared repository provides a comprehensive substrate for the independent verification of our prognostic inferences.
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This research was supported by Soonchunhyang University. The funders had no role in the design of the study; the collection, analysis, and interpretation of data; the writing of the manuscript; or the decision to submit it for publication.
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SHP and WSR conceived and designed the study. BEJ and KBL collected and verified the data. SHP, TJK, SBK, DEK and WSR did the statistical analysis. SHP and WSR interpreted the data. All authors critically revised the manuscript for important intellectual content and agreed to submit the final version for publication. We confirm that the manuscript complies with all instructions to authors.
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This study was conducted following the principles outlined in the Declaration of Helsinki. This study was approved by the Institutional Review Board of Soonchunhyang University Hospital Seoul (IRB No. SCHUH 2025-02-007), and the requirement for informed consent was waived due to the retrospective nature of the study.
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Park, SH., Joo, BE., Kim, T.J. et al. Quantitative assessment of apparent diffusion coefficient for neurological outcome prediction in status epilepticus: a pilot study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-43511-x
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DOI: https://doi.org/10.1038/s41598-026-43511-x
