{
  "ptid_time": "007_S_0128_2007-02-15",
  "img_path": "/data/qiuhui/data/adni/images/007_S_0128/2007-02-15/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 25,281 mm³, 13.2% above the reference mean. With a Z-score of 0.33 (62.9th percentile), this represents normal volume ; hippocampal volume measures 5,994 mm³, 22.0% below the reference mean. With a Z-score of -2.47 (0.7th percentile), this represents significant atrophy; whole brain volume measures 835,569 mm³, 18.8% below the reference mean. With a Z-score of -2.34 (1.0th percentile), this represents significant atrophy; entorhinal cortex volume measures 2,315 mm³, 40.5% below the reference mean. With a Z-score of -3.14 (0.1th percentile), this represents profound atrophy; fusiform gyrus volume measures 16,200 mm³, 11.0% below the reference mean. With a Z-score of -1.24 (10.7th percentile), this represents mild atrophy; middle temporal gyrus volume measures 15,636 mm³, 23.8% below the reference mean. With a Z-score of -2.12 (1.7th percentile), this represents significant atrophy. ",
  "text_data": "Age is 65.1 years. Gender is Female. Education: 20 years. MMSE: 29.0. Logical Memory: 2.0. APOEε4 alleles: 2.0. ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The imaging data reveals significant atrophy in key Alzheimer’s-related regions (hippocampus, entorhinal cortex, middle temporal gyrus, and whole brain), with the entorhinal cortex showing profound atrophy (Z-score -3.14). Despite a normal MMSE score (29/30), the structural changes, combined with APOE4 homozygosity (high genetic risk), strongly suggest neurodegenerative pathology. The discrepancy between imaging and MMSE may indicate early-stage disease or cognitive reserve masking deficits.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (likely prodromal Alzheimer’s disease given the atrophy pattern and APOE4 status).  \n\n**Confidence:** **High** (due to concordance of imaging findings with Alzheimer’s signature atrophy and APOE4 risk, though clinical symptoms are not yet overt).  \n\n**Note:** Close follow-up for progression to dementia is warranted, as MCI with this biomarker profile has a high conversion rate to Alzheimer’s dementia.",
  "timestamp": "2025-07-25T21:46:39.530567"
}