{
  "ptid_time": "130_S_0449_2008-01-28",
  "img_path": "/data/qiuhui/data/adni/images/130_S_0449/2008-01-28/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 26,609 mm³, 19.1% above the reference mean. With a Z-score of 0.48 (68.4th percentile), this represents normal volume ; hippocampal volume measures 5,339 mm³, 30.5% below the reference mean. With a Z-score of -3.43 (0.0th percentile), this represents profound atrophy; whole brain volume measures 953,895 mm³, 7.3% below the reference mean. With a Z-score of -0.91 (18.1th percentile), this represents normal volume ; entorhinal cortex volume measures 2,712 mm³, 30.3% below the reference mean. With a Z-score of -2.35 (0.9th percentile), this represents significant atrophy; fusiform gyrus volume measures 16,626 mm³, 8.7% below the reference mean. With a Z-score of -0.98 (16.4th percentile), this represents normal volume ; middle temporal gyrus volume measures 17,358 mm³, 15.4% below the reference mean. With a Z-score of -1.37 (8.5th percentile), this represents mild atrophy. ",
  "text_data": "Age is 68.0 years. Gender is Female. Education: 14 years. MMSE: 29.0. APOEε4 alleles: 2.0. ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The patient shows profound hippocampal atrophy (Z-score -3.43) and significant entorhinal cortex atrophy (Z-score -2.35), both strongly associated with Alzheimer's pathology. Despite normal MMSE (29/30), these structural changes, combined with APOE4 homozygosity (high genetic risk), suggest early neurodegeneration.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (likely prodromal Alzheimer’s given biomarker severity).  \n**Confidence:** **High** (due to concordance between severe medial temporal atrophy and APOE4 status, though cognitive scores remain intact).  \n\n*Note:* The discrepancy between preserved cognition (MMSE 29) and advanced atrophy may reflect cognitive reserve or early-stage disease. Follow-up with CSF biomarkers (e.g., Aβ42/p-tau) or PET imaging would strengthen certainty.",
  "timestamp": "2025-07-26T14:29:03.867174"
}