{
  "ptid_time": "022_S_4196_2011-09-13",
  "img_path": "/data/qiuhui/data/adni/images/022_S_4196/2011-09-13/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 22,442 mm³, 41.7% below the reference mean. With a Z-score of -1.00 (15.9th percentile), this represents normal volume ; hippocampal volume measures 7,110 mm³, 5.9% below the reference mean. With a Z-score of -0.58 (28.1th percentile), this represents normal volume ; whole brain volume measures 1,069,020 mm³, 1.0% below the reference mean. With a Z-score of -0.12 (45.0th percentile), this represents normal volume ; entorhinal cortex volume measures 3,515 mm³, 14.3% below the reference mean. With a Z-score of -0.97 (16.6th percentile), this represents normal volume ; fusiform gyrus volume measures 17,189 mm³, 8.8% below the reference mean. With a Z-score of -0.75 (22.8th percentile), this represents normal volume ; middle temporal gyrus volume measures 21,876 mm³, 2.5% above the reference mean. With a Z-score of 0.23 (58.9th percentile), this represents normal volume . ",
  "text_data": "Age is 78.4 years. Gender is Male. Education: 14 years. Handedness: Right. Race: White. Medical history: Head, Eyes, Ears, Nose and Throat; Cardiovascular; Dermatologic-Connective Tissue; Endocrine-Metabolic; Renal-Genitourinary; Malignancy. MMSE: 30.0. MoCA: 26.0. Logical Memory: 19.0. Laboratory findings: AST (SGOT): 13.00 (significant reduced). APOEε4 alleles: 0.0. Biomarker levels: Florbetapir (AV45): 1.17 SUVR (normal ); Amyloid beta: 1400.00 pg/mL (normal ); Total tau: 401.40 pg/mL (significant elevated); Phosphorylated tau: 36.31 pg/mL (moderate elevated). ",
  "true_diagnosis": "Diagnosis: CN.",
  "gpt_diagnosis": "**Reasoning:** The brain volumes (hippocampal, whole brain, entorhinal cortex, fusiform gyrus, and middle temporal gyrus) are all within normal ranges based on Z-scores and percentiles. Cognitive testing (MMSE 30, MoCA 26) is normal for age, and amyloid PET (AV45) is normal. However, CSF biomarkers show elevated T-tau and P-tau, which may indicate neurodegeneration despite normal amyloid levels (suggesting possible non-AD pathology).  \n\n**Diagnosis:** **CN (Cognitively Normal)**  \n**Confidence:** **Medium** (due to conflicting CSF biomarkers despite normal imaging and cognition)",
  "timestamp": "2025-07-26T02:17:57.583498"
}