{
  "ptid_time": "032_S_4348_2011-11-18",
  "img_path": "/data/qiuhui/data/adni/images/032_S_4348/2011-11-18/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 15,982 mm³, 28.5% below the reference mean. With a Z-score of -0.71 (23.8th percentile), this represents normal volume ; hippocampal volume measures 6,992 mm³, 9.0% below the reference mean. With a Z-score of -1.01 (15.6th percentile), this represents mild atrophy; whole brain volume measures 914,344 mm³, 11.2% below the reference mean. With a Z-score of -1.39 (8.2th percentile), this represents mild atrophy; entorhinal cortex volume measures 3,300 mm³, 15.2% below the reference mean. With a Z-score of -1.18 (11.9th percentile), this represents mild atrophy; fusiform gyrus volume measures 13,996 mm³, 23.1% below the reference mean. With a Z-score of -2.61 (0.5th percentile), this represents significant atrophy; middle temporal gyrus volume measures 16,944 mm³, 17.4% below the reference mean. With a Z-score of -1.55 (6.1th percentile), this represents moderate atrophy. ",
  "text_data": "Age is 66.1 years. Gender is Female. Education: 17 years. Handedness: Right. Race: White. Medical history: Psychiatric; Cardiovascular; Musculoskeletal; Gastrointestinal; Allergies or Drug Sensitivities; Smoking; Major Surgical Procedures. MMSE: 30.0. MoCA: 25.0. Logical Memory: 14.0. Laboratory findings: Vitamin B12: 1335.00 (profound elevated); WBC: 12.33 (profound elevated); Neutrophils: 8.26 (profound elevated); Lymphocytes: 3.38 (profound elevated); Calcium (EDTA): 10.70 (significant elevated). APOEε4 alleles: 2.0. Biomarker levels: Florbetapir (AV45): 1.42 SUVR (significant elevated); Amyloid beta: 798.60 pg/mL (normal ); Total tau: 218.90 pg/mL (normal ); Phosphorylated tau: 18.37 pg/mL (normal ). ",
  "true_diagnosis": "Diagnosis: CN.",
  "gpt_diagnosis": "Reasoning: The imaging shows mild to significant atrophy in key Alzheimer's-related regions (hippocampus, entorhinal cortex, fusiform gyrus, middle temporal gyrus), particularly the fusiform gyrus (Z-score -2.61). Despite normal CSF biomarkers (Aβ, tau), elevated AV45 (amyloid PET) suggests amyloid pathology. The MoCA score of 25 indicates subtle cognitive impairment, while MMSE is normal. APOE4 homozygosity increases AD risk.  \n\nDiagnosis: **Mild Cognitive Impairment (MCI)**  \nConfidence: **Medium**  \n*(High amyloid burden with structural atrophy and borderline MoCA, but normal CSF biomarkers and MMSE introduce some uncertainty.)*",
  "timestamp": "2025-07-26T05:04:22.348771"
}