{
  "ptid_time": "037_S_0566_2007-02-16",
  "img_path": "/data/qiuhui/data/adni/images/037_S_0566/2007-02-16/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 31,272 mm³, 18.8% below the reference mean. With a Z-score of -0.45 (32.6th percentile), this represents normal volume ; hippocampal volume measures 4,670 mm³, 38.2% below the reference mean. With a Z-score of -3.73 (0.0th percentile), this represents profound atrophy; whole brain volume measures 887,981 mm³, 17.7% below the reference mean. With a Z-score of -2.30 (1.1th percentile), this represents significant atrophy; entorhinal cortex volume measures 2,313 mm³, 43.6% below the reference mean. With a Z-score of -2.96 (0.2th percentile), this represents significant atrophy; fusiform gyrus volume measures 14,291 mm³, 24.1% below the reference mean. With a Z-score of -2.06 (2.0th percentile), this represents significant atrophy; middle temporal gyrus volume measures 19,004 mm³, 10.9% below the reference mean. With a Z-score of -0.98 (16.3th percentile), this represents normal volume . ",
  "text_data": "Age is 79.3 years. Gender is Male. Education: 20 years. MMSE: 28.0. APOEε4 alleles: 1.0. ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The hippocampal volume shows profound atrophy (Z-score -3.73, 0.0th percentile), and significant atrophy is present in the whole brain, entorhinal cortex, and fusiform gyrus. Despite the normal MMSE score (28/30), such severe atrophy in Alzheimer’s-vulnerable regions strongly suggests neurodegeneration. The presence of one APOE4 allele further increases Alzheimer’s risk.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (likely prodromal Alzheimer’s given biomarker severity).  \n\n**Confidence:** **High** (structural atrophy is severe and localized to Alzheimer’s signature regions, outweighing the normal MMSE).  \n\n*Note:* The MMSE may underestimate impairment due to its insensitivity to early Alzheimer’s, especially in high-functioning individuals. A more detailed neuropsychological exam (e.g., delayed recall tests) would likely reveal deficits. Biomarker evidence (e.g., amyloid PET/CSF) could confirm Alzheimer’s pathology.",
  "timestamp": "2025-07-26T06:32:55.766925"
}