{
  "ptid_time": "041_S_4041_2011-05-24",
  "img_path": "/data/qiuhui/data/adni/images/041_S_4041/2011-05-24/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 23,431 mm³, 16.5% below the reference mean. With a Z-score of -0.38 (35.3th percentile), this represents normal volume ; hippocampal volume measures 5,307 mm³, 25.4% below the reference mean. With a Z-score of -2.33 (1.0th percentile), this represents significant atrophy; whole brain volume measures 825,502 mm³, 15.3% below the reference mean. With a Z-score of -1.93 (2.7th percentile), this represents moderate atrophy; entorhinal cortex volume measures 2,350 mm³, 36.0% below the reference mean. With a Z-score of -2.21 (1.4th percentile), this represents significant atrophy; fusiform gyrus volume measures 15,820 mm³, 7.0% below the reference mean. With a Z-score of -0.64 (26.2th percentile), this represents normal volume ; middle temporal gyrus volume measures 16,502 mm³, 13.9% below the reference mean. With a Z-score of -1.21 (11.4th percentile), this represents mild atrophy. ",
  "text_data": "Age is 77.9 years. Gender is Female. Education: 18 years. Handedness: Right. Race: White. Medical history: Psychiatric; Endocrine-Metabolic. MMSE: 30.0. MoCA: 26.0. Logical Memory: 11.0. Laboratory findings: Serum Glucose: 142.00 (profound elevated); AST (SGOT): 14.00 (significant reduced). APOEε4 alleles: 0.0. Biomarker levels: Florbetapir (AV45): 0.99 SUVR (normal ); Total tau: 377.90 pg/mL (moderate elevated); Phosphorylated tau: 30.42 pg/mL (mild elevated). ",
  "true_diagnosis": "Diagnosis: CN.",
  "gpt_diagnosis": "**Reasoning:** The patient shows significant atrophy in the hippocampus and entorhinal cortex, which are key regions affected in Alzheimer's disease, along with moderate whole-brain atrophy. Despite normal cognitive screening scores (MMSE 30, MoCA 26), the structural changes and moderately elevated T-tau suggest early neurodegenerative pathology. The absence of APOE4 and normal amyloid (AV45) may indicate non-amyloid mechanisms or early-stage disease.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)**  \n**Confidence:** **Medium** (due to conflicting biomarkers—normal amyloid but elevated tau and structural atrophy—and preserved cognition despite significant neurodegeneration).",
  "timestamp": "2025-07-26T07:10:35.355962"
}