{
  "ptid_time": "094_S_1398_2007-05-03",
  "img_path": "/data/qiuhui/data/adni/images/094_S_1398/2007-05-03/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 44,215 mm³, 57.5% above the reference mean. With a Z-score of 1.32 (90.6th percentile), this represents mild enlargement; hippocampal volume measures 3,281 mm³, 53.9% below the reference mean. With a Z-score of -4.94 (0.0th percentile), this represents profound atrophy; whole brain volume measures 669,364 mm³, 31.3% below the reference mean. With a Z-score of -3.94 (0.0th percentile), this represents profound atrophy; entorhinal cortex volume measures 1,579 mm³, 57.0% below the reference mean. With a Z-score of -3.50 (0.0th percentile), this represents profound atrophy; fusiform gyrus volume measures 11,849 mm³, 30.4% below the reference mean. With a Z-score of -2.76 (0.3th percentile), this represents significant atrophy; middle temporal gyrus volume measures 12,622 mm³, 34.2% below the reference mean. With a Z-score of -2.97 (0.2th percentile), this represents significant atrophy. ",
  "text_data": "Age is 77.6 years. Gender is Female. Education: 16 years. Handedness: Right. Race: White. Medical history: Psychiatric; Musculoskeletal; Allergies or Drug Sensitivities; Major Surgical Procedures. MMSE: 24.0. Logical Memory: 0.0. APOEε4 alleles: 1.0. Biomarker levels: Pittsburgh compound B: 1.20 SUVR (mild reduced); Amyloid beta: 689.20 pg/mL (normal ); Total tau: 232.50 pg/mL (normal ); Phosphorylated tau: 17.01 pg/mL (normal ). ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The imaging data show profound atrophy in the hippocampus, entorhinal cortex, and whole brain, along with significant atrophy in the fusiform gyrus and middle temporal gyrus—all key regions affected in Alzheimer’s disease (AD). Despite normal CSF biomarkers (Aβ, T-tau, P-tau), the structural changes are severe and consistent with neurodegeneration. The MMSE score of 24 suggests mild cognitive impairment, but the degree of atrophy is more typical of dementia.  \n\n**Diagnosis:** **Dementia** (likely Alzheimer’s disease, biomarker-negative atypical variant or advanced neurodegeneration outweighing CSF profiles).  \n\n**Confidence:** **Medium** (high confidence in neurodegeneration, but the discordance with CSF biomarkers lowers certainty about AD-specific pathology).",
  "timestamp": "2025-07-26T10:23:16.412557"
}