{
  "ptid_time": "011_S_0003_2005-09-01",
  "img_path": "/data/qiuhui/data/adni/images/011_S_0003/2005-09-01/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 84,599 mm³, 79.9% above the reference mean. With a Z-score of 2.32 (99.0th percentile), this represents significant enlargement; hippocampal volume measures 5,319 mm³, 23.7% below the reference mean. With a Z-score of -2.04 (2.0th percentile), this represents significant atrophy; whole brain volume measures 1,129,830 mm³, 9.8% above the reference mean. With a Z-score of 1.28 (90.0th percentile), this represents mild enlargement; entorhinal cortex volume measures 1,791 mm³, 54.9% below the reference mean. With a Z-score of -3.59 (0.0th percentile), this represents profound atrophy; fusiform gyrus volume measures 15,506 mm³, 14.2% below the reference mean. With a Z-score of -1.23 (11.0th percentile), this represents mild atrophy; middle temporal gyrus volume measures 18,422 mm³, 8.7% below the reference mean. With a Z-score of -0.78 (21.8th percentile), this represents normal volume . ",
  "text_data": "Age is 81.3 years. Gender is Male. Education: 18 years. Handedness: Right. Race: White. Medical history: Head, Eyes, Ears, Nose and Throat; Cardiovascular; Musculoskeletal; Endocrine-Metabolic; Renal-Genitourinary; Smoking; Malignancy; Major Surgical Procedures. MMSE: 20.0. Logical Memory: 2.0. APOEε4 alleles: 1.0. Biomarker levels: Amyloid beta: 741.50 pg/mL (normal ); Total tau: 239.70 pg/mL (normal ); Phosphorylated tau: 22.83 pg/mL (normal ). ",
  "true_diagnosis": "Diagnosis: AD.",
  "gpt_diagnosis": "**Reasoning:** The imaging data shows significant hippocampal and entorhinal cortex atrophy, both key regions affected in Alzheimer's disease (AD), alongside ventricular enlargement (a marker of neurodegeneration). However, CSF biomarkers (Aβ, T-tau, P-tau) are normal, which is atypical for AD. The MMSE score of 20 suggests cognitive impairment, but the lack of biomarker support complicates the diagnosis.  \n\n**Diagnosis:** **MCI** (given cognitive decline and structural changes, but normal biomarkers reduce certainty for dementia due to AD).  \n\n**Confidence:** **Medium** (conflicting evidence between imaging and biomarkers).  \n\n*Alternative considerations:*  \n- **Hippocampal sclerosis** (severe hippocampal/entorhinal atrophy with normal biomarkers).  \n- **Primary age-related tauopathy (PART)** (tau pathology without Aβ, but usually less severe atrophy).  \n- **Non-AD neurodegenerative process** (e.g., LATE-NC).  \nFurther clinical correlation (e.g., FDG-PET, neuropsychological testing) would help clarify.",
  "timestamp": "2025-07-25T22:36:31.937545"
}