{
  "ptid_time": "073_S_4311_2016-01-14",
  "img_path": "/data/qiuhui/data/adni/images/073_S_4311/2016-01-14/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 37,990 mm³, 35.4% above the reference mean. With a Z-score of 0.81 (79.1th percentile), this represents normal volume ; hippocampal volume measures 5,526 mm³, 22.3% below the reference mean. With a Z-score of -2.05 (2.0th percentile), this represents significant atrophy; whole brain volume measures 1,018,410 mm³, 4.5% above the reference mean. With a Z-score of 0.57 (71.4th percentile), this represents normal volume ; entorhinal cortex volume measures 2,718 mm³, 26.0% below the reference mean. With a Z-score of -1.60 (5.5th percentile), this represents moderate atrophy; fusiform gyrus volume measures 16,176 mm³, 4.9% below the reference mean. With a Z-score of -0.45 (32.7th percentile), this represents normal volume ; middle temporal gyrus volume measures 16,863 mm³, 12.0% below the reference mean. With a Z-score of -1.04 (14.8th percentile), this represents mild atrophy. ",
  "text_data": "Age is 76.5 years. Gender is Female. Education: 18 years. MMSE: 29.0. MoCA: 18.0. Logical Memory: 13.0. APOEε4 alleles: 0.0. ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The patient shows significant hippocampal atrophy (Z-score -2.05, 2nd percentile) and moderate entorhinal cortex atrophy (Z-score -1.60, 5.5th percentile), both key regions in Alzheimer's pathology. Despite a normal MMSE (29), the low MoCA (18) suggests cognitive impairment, likely due to the structural deficits.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (likely amnestic subtype given hippocampal/entorhinal involvement).  \n\n**Confidence:** **Medium** (high confidence in atrophy-related impairment, but MoCA-MMSE discrepancy warrants further clinical correlation).  \n\n*Note:* The absence of APOE4 reduces Alzheimer’s genetic risk but doesn’t rule it out. Progression to dementia is likely if atrophy worsens. Recommend CSF biomarkers/PET for etiology.",
  "timestamp": "2025-07-26T09:43:08.866126"
}