{
  "ptid_time": "036_S_2380_2018-06-18",
  "img_path": "/data/qiuhui/data/adni/images/036_S_2380/2018-06-18/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 32,516 mm³, 15.6% below the reference mean. With a Z-score of -0.37 (35.4th percentile), this represents normal volume ; hippocampal volume measures 6,249 mm³, 17.3% below the reference mean. With a Z-score of -1.69 (4.5th percentile), this represents moderate atrophy; whole brain volume measures 1,197,090 mm³, 10.9% above the reference mean. With a Z-score of 1.42 (92.2th percentile), this represents mild enlargement; entorhinal cortex volume measures 2,405 mm³, 41.3% below the reference mean. With a Z-score of -2.80 (0.3th percentile), this represents significant atrophy; fusiform gyrus volume measures 19,554 mm³, 3.8% above the reference mean. With a Z-score of 0.32 (62.7th percentile), this represents normal volume ; middle temporal gyrus volume measures 17,595 mm³, 17.5% below the reference mean. With a Z-score of -1.58 (5.7th percentile), this represents moderate atrophy. ",
  "text_data": "Age is 74.8 years. Gender is Male. Education: 16 years. MMSE: 30.0. MoCA: 22.0. Logical Memory: 8.0. APOEε4 alleles: 2.0. Biomarker levels: Florbetapir (AV45): 1.42 SUVR (significant elevated). ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The hippocampal and entorhinal cortex volumes show significant atrophy (Z-scores -1.69 and -2.80, respectively), which are key biomarkers for Alzheimer's disease. The MoCA score of 22 suggests cognitive impairment, while the MMSE of 30 is less sensitive. Elevated AV45 (amyloid PET) and APOE4 homozygosity further support Alzheimer's pathology.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (likely prodromal Alzheimer's disease given biomarker profile).  \n\n**Confidence:** **High** (due to concordance between structural atrophy in AD-vulnerable regions, amyloid positivity, and APOE4 risk).  \n\n*Note: Despite the normal MMSE, the MoCA and imaging/biomarkers strongly suggest MCI due to AD. Progression to dementia is likely if amyloid and neurodegeneration persist.*",
  "timestamp": "2025-07-26T06:12:16.040717"
}