{
  "ptid_time": "116_S_4092_2011-06-24",
  "img_path": "/data/qiuhui/data/adni/images/116_S_4092/2011-06-24/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 42,644 mm³, 15.4% above the reference mean. With a Z-score of 0.41 (66.1th percentile), this represents normal volume ; hippocampal volume measures 6,832 mm³, 5.2% above the reference mean. With a Z-score of 0.42 (66.1th percentile), this represents normal volume ; whole brain volume measures 1,051,500 mm³, 13.3% above the reference mean. With a Z-score of 1.59 (94.5th percentile), this represents moderate enlargement; entorhinal cortex volume measures 3,361 mm³, 2.9% below the reference mean. With a Z-score of -0.16 (43.7th percentile), this represents normal volume ; fusiform gyrus volume measures 20,706 mm³, 28.5% above the reference mean. With a Z-score of 2.14 (98.4th percentile), this represents significant enlargement; middle temporal gyrus volume measures 19,216 mm³, 6.6% above the reference mean. With a Z-score of 0.59 (72.1th percentile), this represents normal volume . ",
  "text_data": "Age is 81.5 years. Gender is Female. Education: 14 years. Handedness: Right. Race: White. Medical history: Neurologic; Head, Eyes, Ears, Nose and Throat; Dermatologic-Connective Tissue; Musculoskeletal; Gastrointestinal; Allergies or Drug Sensitivities; Malignancy; Major Surgical Procedures. MMSE: 29.0. MoCA: 26.0. Logical Memory: 9.0. Laboratory findings: Monocytes: 0.63 (significant elevated); Monocytes: 12.00 (profound elevated); Basophils: 1.50 (significant elevated). APOEε4 alleles: 0.0. Biomarker levels: Florbetapir (AV45): 1.28 SUVR (moderate elevated); Amyloid beta: 1261.00 pg/mL (normal ); Total tau: 433.20 pg/mL (significant elevated); Phosphorylated tau: 41.02 pg/mL (significant elevated). ",
  "true_diagnosis": "Diagnosis: CN.",
  "gpt_diagnosis": "**Reasoning:** The brain volume measurements are largely within normal ranges or even enlarged, with no significant atrophy in key regions like the hippocampus or entorhinal cortex. However, the elevated T-tau and P-tau levels, along with moderate AV45 (amyloid) elevation, suggest underlying neurodegenerative pathology despite normal Aβ. The high MMSE (29) and MoCA (26) scores indicate preserved cognitive function.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)**  \n**Confidence:** **Medium** (due to biomarker abnormalities despite normal cognition and brain volumes)  \n\n*Note:* The elevated tau and AV45 suggest Alzheimer’s pathology, but the lack of cognitive decline or significant atrophy makes dementia unlikely at this stage. MCI is the most fitting diagnosis, though the high test scores could also argue for **CN (Cognitively Normal) with preclinical AD changes**. Confidence is medium due to this ambiguity.",
  "timestamp": "2025-07-26T12:07:04.964238"
}