{
  "ptid_time": "130_S_4589_2012-03-19",
  "img_path": "/data/qiuhui/data/adni/images/130_S_4589/2012-03-19/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 27,455 mm³, 2.2% below the reference mean. With a Z-score of -0.05 (48.0th percentile), this represents normal volume ; hippocampal volume measures 7,397 mm³, 4.0% above the reference mean. With a Z-score of 0.36 (64.2th percentile), this represents normal volume ; whole brain volume measures 1,064,030 mm³, 9.2% above the reference mean. With a Z-score of 1.15 (87.6th percentile), this represents mild enlargement; entorhinal cortex volume measures 3,237 mm³, 11.9% below the reference mean. With a Z-score of -0.73 (23.3th percentile), this represents normal volume ; fusiform gyrus volume measures 16,642 mm³, 2.2% below the reference mean. With a Z-score of -0.20 (42.1th percentile), this represents normal volume ; middle temporal gyrus volume measures 17,797 mm³, 7.2% below the reference mean. With a Z-score of -0.62 (26.7th percentile), this represents normal volume . ",
  "text_data": "Age is 75.1 years. Gender is Female. Education: 14 years. Handedness: Right. Race: White. Medical history: Head, Eyes, Ears, Nose and Throat; Musculoskeletal; Endocrine-Metabolic; Gastrointestinal; Renal-Genitourinary; Major Surgical Procedures. MMSE: 26.0. MoCA: 18.0. Logical Memory: 4.0. APOEε4 alleles: 2.0. Biomarker levels: Florbetapir (AV45): 1.23 SUVR (mild elevated); Amyloid beta: 805.30 pg/mL (normal ); Total tau: 268.10 pg/mL (normal ); Phosphorylated tau: 24.39 pg/mL (normal ). ",
  "true_diagnosis": "Diagnosis: AD.",
  "gpt_diagnosis": "**Reasoning:** The brain volume measurements are largely within normal ranges, with only mild enlargement in whole brain volume and mild reduction in entorhinal cortex and middle temporal gyrus volumes. However, the MoCA score of 18 is significantly below the typical cutoff for normal cognition (≥26), suggesting cognitive impairment. Despite normal CSF biomarkers (Aβ, T-tau, P-tau), the mildly elevated AV45 (amyloid PET) raises suspicion of early amyloid deposition. The presence of two APOE4 alleles also increases Alzheimer's risk.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)**  \n**Confidence:** **Medium** (due to conflicting biomarkers—normal CSF but elevated AV45—and the significant MoCA impairment despite mostly normal brain volumes).",
  "timestamp": "2025-07-26T14:48:27.793099"
}