{
  "ptid_time": "072_S_2093_2010-10-08",
  "img_path": "/data/qiuhui/data/adni/images/072_S_2093/2010-10-08/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 18,338 mm³, 1.5% below the reference mean. With a Z-score of -0.04 (48.3th percentile), this represents normal volume ; hippocampal volume measures 8,480 mm³, 8.6% above the reference mean. With a Z-score of 1.20 (88.4th percentile), this represents mild enlargement; whole brain volume measures 1,078,910 mm³, 3.7% above the reference mean. With a Z-score of 0.44 (67.1th percentile), this represents normal volume ; entorhinal cortex volume measures 2,972 mm³, 19.6% below the reference mean. With a Z-score of -1.53 (6.3th percentile), this represents moderate atrophy; fusiform gyrus volume measures 17,999 mm³, 2.3% below the reference mean. With a Z-score of -0.21 (41.6th percentile), this represents normal volume ; middle temporal gyrus volume measures 23,451 mm³, 14.2% above the reference mean. With a Z-score of 1.17 (87.9th percentile), this represents mild enlargement. ",
  "text_data": "Age is 59.5 years. Gender is Female. Education: 16 years. Handedness: Left. Race: White. Medical history: Head, Eyes, Ears, Nose and Throat; Musculoskeletal; Endocrine-Metabolic; Gastrointestinal; Renal-Genitourinary; Major Surgical Procedures. MMSE: 28.0. MoCA: 24.0. Logical Memory: 11.0. APOEε4 alleles: 1.0. Biomarker levels: Florbetapir (AV45): 1.03 SUVR (normal ); Total tau: 354.60 pg/mL (mild elevated); Phosphorylated tau: 30.84 pg/mL (mild elevated). ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The entorhinal cortex shows moderate atrophy (Z-score -1.53, 6.3th percentile), which is a key early marker of Alzheimer’s pathology. Despite normal hippocampal and whole brain volumes, the mild elevation in T-tau and P-tau, along with a slightly reduced MoCA score (24/30), suggests early cognitive changes. The preserved MMSE (28/30) and normal AV45 (amyloid PET) complicate the picture but do not rule out early neurodegeneration.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)**  \n**Confidence:** **Medium** (due to conflicting biomarkers—normal amyloid but elevated tau and entorhinal atrophy—along with borderline MoCA).  \n\n*Note: Given the APOE4 carrier status and tau elevation, this could represent early Alzheimer’s pathophysiology, but the normal amyloid scan lowers confidence in a dementia diagnosis at this stage.*",
  "timestamp": "2025-07-26T09:12:50.380307"
}