{
  "ptid_time": "032_S_6279_2018-04-04",
  "img_path": "/data/qiuhui/data/adni/images/032_S_6279/2018-04-04/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 63,227 mm³, 34.5% above the reference mean. With a Z-score of 1.00 (84.2th percentile), this represents mild enlargement; hippocampal volume measures 5,630 mm³, 19.2% below the reference mean. With a Z-score of -1.66 (4.8th percentile), this represents moderate atrophy; whole brain volume measures 991,078 mm³, 3.7% below the reference mean. With a Z-score of -0.48 (31.4th percentile), this represents normal volume ; entorhinal cortex volume measures 3,081 mm³, 22.4% below the reference mean. With a Z-score of -1.46 (7.2th percentile), this represents mild atrophy; fusiform gyrus volume measures 15,109 mm³, 16.4% below the reference mean. With a Z-score of -1.42 (7.8th percentile), this represents mild atrophy; middle temporal gyrus volume measures 16,537 mm³, 18.0% below the reference mean. With a Z-score of -1.62 (5.3th percentile), this represents moderate atrophy. ",
  "text_data": "Age is 89.1 years. Gender is Male. Education: 20 years. MMSE: 26.0. Logical Memory: 3.0. APOEε4 alleles: 0.0. Biomarker levels: Florbetapir (AV45): 1.15 SUVR (normal ). ",
  "true_diagnosis": "Diagnosis: CN.",
  "gpt_diagnosis": "**Reasoning:** The imaging data shows moderate hippocampal atrophy (Z-score -1.66, 4.8th percentile) and mild-to-moderate atrophy in other temporolimbic regions (entorhinal cortex, fusiform gyrus, middle temporal gyrus), alongside mild ventricular enlargement. The MMSE score of 26 is borderline, but given the significant atrophy in Alzheimer’s-vulnerable regions and normal AV45 (amyloid PET), this likely reflects early neurodegeneration. The absence of APOE4 and normal amyloid reduces Alzheimer’s likelihood but doesn’t rule out other dementias (e.g., hippocampal sclerosis, PART, or age-related tauopathy).  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (or possibly early dementia if functional decline is present, but clinical correlation needed).  \n\n**Confidence:** **Medium** (due to borderline MMSE, lack of amyloid data, and need for functional assessment).",
  "timestamp": "2025-07-26T05:08:30.700261"
}