{
  "ptid_time": "121_S_1322_2008-04-09",
  "img_path": "/data/qiuhui/data/adni/images/121_S_1322/2008-04-09/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 22,977 mm³, 18.1% below the reference mean. With a Z-score of -0.42 (33.9th percentile), this represents normal volume ; hippocampal volume measures 5,206 mm³, 26.8% below the reference mean. With a Z-score of -2.46 (0.7th percentile), this represents significant atrophy; whole brain volume measures 963,058 mm³, 1.2% below the reference mean. With a Z-score of -0.15 (44.0th percentile), this represents normal volume ; entorhinal cortex volume measures 2,341 mm³, 36.3% below the reference mean. With a Z-score of -2.23 (1.3th percentile), this represents significant atrophy; fusiform gyrus volume measures 18,343 mm³, 7.8% above the reference mean. With a Z-score of 0.71 (76.2th percentile), this represents normal volume ; middle temporal gyrus volume measures 19,946 mm³, 4.1% above the reference mean. With a Z-score of 0.35 (63.7th percentile), this represents normal volume . ",
  "text_data": "Age is 72.7 years. Gender is Female. Education: 12 years. MMSE: 28.0. Logical Memory: 4.0. APOEε4 alleles: 2.0. ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The data shows significant atrophy in the hippocampus (Z-score -2.46, 0.7th percentile) and entorhinal cortex (Z-score -2.23, 1.3th percentile), which are key regions affected in Alzheimer's disease. Despite normal MMSE (28/30), the presence of APOE4 homozygosity (2 alleles) and focal atrophy in memory-related structures suggests early neurodegenerative changes.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (likely prodromal Alzheimer’s given APOE4 and medial temporal atrophy).  \n\n**Confidence:** **Medium** (high for neurodegeneration, but MCI diagnosis is provisional without longitudinal cognitive decline or biomarker confirmation like amyloid PET/CSF).  \n\n*Note: Amyloid/tau biomarkers would increase confidence in an Alzheimer’s etiology.*",
  "timestamp": "2025-07-26T12:20:37.236429"
}