{
  "ptid_time": "126_S_2407_2011-11-21",
  "img_path": "/data/qiuhui/data/adni/images/126_S_2407/2011-11-21/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 17,644 mm³, 21.0% below the reference mean. With a Z-score of -0.53 (30.0th percentile), this represents normal volume ; hippocampal volume measures 3,731 mm³, 51.4% below the reference mean. With a Z-score of -5.77 (0.0th percentile), this represents profound atrophy; whole brain volume measures 919,445 mm³, 10.7% below the reference mean. With a Z-score of -1.33 (9.2th percentile), this represents mild atrophy; entorhinal cortex volume measures 2,351 mm³, 39.6% below the reference mean. With a Z-score of -3.07 (0.1th percentile), this represents profound atrophy; fusiform gyrus volume measures 16,426 mm³, 9.8% below the reference mean. With a Z-score of -1.10 (13.5th percentile), this represents mild atrophy; middle temporal gyrus volume measures 21,110 mm³, 2.9% above the reference mean. With a Z-score of 0.26 (60.1th percentile), this represents normal volume . ",
  "text_data": "Age is 68.0 years. Gender is Female. Education: 16 years. Handedness: Right. Race: White. Medical history: Psychiatric; Head, Eyes, Ears, Nose and Throat; Musculoskeletal; Endocrine-Metabolic; Renal-Genitourinary; Smoking; Major Surgical Procedures. MMSE: 26.0. MoCA: 20.0. Logical Memory: 9.0. Laboratory findings: ALT (SGPT): 4.00 (significant reduced). APOEε4 alleles: 0.0. Biomarker levels: Florbetapir (AV45): 1.00 SUVR (normal ); Total tau: 242.40 pg/mL (normal ); Phosphorylated tau: 17.79 pg/mL (normal ). ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The hippocampal and entorhinal cortex volumes show profound atrophy (Z-scores of -5.77 and -3.07, respectively), which are strongly associated with Alzheimer's pathology. The MMSE (26) is borderline, but the MoCA (20) suggests cognitive impairment. Normal CSF biomarkers (T-tau, P-tau, AV45) and lack of APOE4 reduce the likelihood of typical Alzheimer’s, but the structural atrophy is concerning.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (likely amnestic subtype given hippocampal atrophy).  \n\n**Confidence:** **Medium** (due to conflicting biomarkers—normal CSF but severe atrophy—and borderline cognitive scores).",
  "timestamp": "2025-07-26T12:44:41.135437"
}