{
  "ptid_time": "067_S_5160_2013-05-17",
  "img_path": "/data/qiuhui/data/adni/images/067_S_5160/2013-05-17/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 28,170 mm³, 23.8% below the reference mean. With a Z-score of -0.64 (26.0th percentile), this represents normal volume ; whole brain volume measures 940,638 mm³, 1.3% above the reference mean. With a Z-score of 0.16 (56.4th percentile), this represents normal volume ; entorhinal cortex volume measures 2,382 mm³, 31.2% below the reference mean. With a Z-score of -1.68 (4.6th percentile), this represents moderate atrophy; fusiform gyrus volume measures 16,481 mm³, 2.3% above the reference mean. With a Z-score of 0.17 (56.9th percentile), this represents normal volume ; middle temporal gyrus volume measures 16,124 mm³, 10.6% below the reference mean. With a Z-score of -0.94 (17.4th percentile), this represents normal volume . ",
  "text_data": "Age is 84.1 years. Gender is Female. Education: 18 years. Handedness: Right. Race: White. Medical history: Cardiovascular; Endocrine-Metabolic; Gastrointestinal; Hematopoietic-Lymphatic; Malignancy; Major Surgical Procedures. MMSE: 28.0. MoCA: 21.0. Logical Memory: 9.0. APOEε4 alleles: 0.0. Biomarker levels: Florbetapir (AV45): 0.91 SUVR (mild reduced); Amyloid beta: 1213.00 pg/mL (normal ); Total tau: 164.10 pg/mL (normal ); Phosphorylated tau: 13.60 pg/mL (mild reduced). ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The entorhinal cortex shows moderate atrophy (Z-score -1.68, 4.6th percentile), which is a key early marker of Alzheimer's pathology, while other brain volumes are largely normal. The MoCA score (21/30) suggests mild cognitive impairment, but the MMSE (28/30) is near-normal, indicating possible early-stage cognitive decline. Biomarkers (Aβ, T-tau normal; P-tau, AV45 mildly reduced) do not strongly support amyloid pathology.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)**  \n**Confidence:** **Medium** (due to conflicting cognitive scores and lack of strong biomarker evidence for AD, but entorhinal atrophy is concerning).",
  "timestamp": "2025-07-26T08:42:39.164909"
}