{
  "ptid_time": "027_S_5169_2013-05-22",
  "img_path": "/data/qiuhui/data/adni/images/027_S_5169/2013-05-22/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 15,460 mm³, 30.8% below the reference mean. With a Z-score of -0.77 (22.1th percentile), this represents normal volume ; hippocampal volume measures 9,008 mm³, 17.2% above the reference mean. With a Z-score of 1.93 (97.3th percentile), this represents moderate enlargement; whole brain volume measures 1,079,580 mm³, 4.9% above the reference mean. With a Z-score of 0.61 (72.9th percentile), this represents normal volume ; entorhinal cortex volume measures 2,615 mm³, 32.8% below the reference mean. With a Z-score of -2.54 (0.5th percentile), this represents significant atrophy; fusiform gyrus volume measures 17,308 mm³, 5.0% below the reference mean. With a Z-score of -0.56 (28.8th percentile), this represents normal volume ; middle temporal gyrus volume measures 23,714 mm³, 15.6% above the reference mean. With a Z-score of 1.38 (91.7th percentile), this represents mild enlargement. ",
  "text_data": "Age is 65.7 years. Gender is Female. Education: 18 years. Handedness: Right. Race: White. Medical history: Neurologic; Musculoskeletal; Endocrine-Metabolic; Gastrointestinal; Allergies or Drug Sensitivities. MMSE: 30.0. MoCA: 29.0. Logical Memory: 19.0. APOEε4 alleles: 1.0. Biomarker levels: Florbetapir (AV45): 1.08 SUVR (normal ); Amyloid beta: 1490.00 pg/mL (mild elevated); Total tau: 292.90 pg/mL (normal ); Phosphorylated tau: 26.06 pg/mL (normal ). ",
  "true_diagnosis": "Diagnosis: CN.",
  "gpt_diagnosis": "**Reasoning:** The entorhinal cortex shows significant atrophy (Z-score -2.54, 0.5th percentile), which is a strong biomarker for early Alzheimer's pathology. However, hippocampal volume is paradoxically enlarged (Z-score 1.93, 97.3th percentile), which may reflect compensatory mechanisms or measurement variability. Cognitive scores (MMSE 30, MoCA 29) are intact, and CSF biomarkers show only mild Aβ elevation without elevated tau.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (due to structural changes in the entorhinal cortex and mild Aβ elevation, despite normal cognition).  \n**Confidence:** **Medium** (atypical hippocampal enlargement complicates interpretation, but entorhinal atrophy and Aβ elevation suggest early neurodegeneration).",
  "timestamp": "2025-07-26T04:10:14.688956"
}