{
  "ptid_time": "137_S_4756_2012-05-31",
  "img_path": "/data/qiuhui/data/adni/images/137_S_4756/2012-05-31/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 57,687 mm³, 22.7% above the reference mean. With a Z-score of 0.66 (74.5th percentile), this represents normal volume ; hippocampal volume measures 5,064 mm³, 27.3% below the reference mean. With a Z-score of -2.36 (0.9th percentile), this represents significant atrophy; whole brain volume measures 907,256 mm³, 11.8% below the reference mean. With a Z-score of -1.55 (6.0th percentile), this represents moderate atrophy; entorhinal cortex volume measures 2,168 mm³, 45.4% below the reference mean. With a Z-score of -2.97 (0.1th percentile), this represents significant atrophy; fusiform gyrus volume measures 14,529 mm³, 19.6% below the reference mean. With a Z-score of -1.70 (4.5th percentile), this represents moderate atrophy; middle temporal gyrus volume measures 15,511 mm³, 23.1% below the reference mean. With a Z-score of -2.07 (1.9th percentile), this represents significant atrophy. ",
  "text_data": "Age is 84.2 years. Gender is Male. Education: 16 years. Handedness: Right. Race: White. Medical history: Psychiatric; Head, Eyes, Ears, Nose and Throat; Respiratory; Endocrine-Metabolic; Gastrointestinal; Renal-Genitourinary; Allergies or Drug Sensitivities; Smoking; Major Surgical Procedures. MMSE: 24.0. MoCA: 19.0. Logical Memory: 1.0. APOEε4 alleles: 1.0. Biomarker levels: Florbetapir (AV45): 1.47 SUVR (profound elevated); Amyloid beta: 675.30 pg/mL (normal ); Total tau: 266.80 pg/mL (normal ); Phosphorylated tau: 27.12 pg/mL (normal ). ",
  "true_diagnosis": "Diagnosis: AD.",
  "gpt_diagnosis": "**Reasoning:** The imaging data shows significant atrophy in the hippocampus, entorhinal cortex, and middle temporal gyrus—key regions affected in Alzheimer’s disease (AD). Despite normal Aβ and tau biomarkers, the profound elevation in AV45 (amyloid PET) suggests amyloid pathology. The cognitive scores (MMSE 24, MoCA 19) indicate mild cognitive impairment, but the structural atrophy pattern is more consistent with early dementia.  \n\n**Diagnosis:** **Dementia (likely Alzheimer’s disease)**  \n**Confidence:** **Medium** (due to conflicting biomarkers—normal CSF Aβ/tau but elevated AV45—though imaging and cognitive deficits strongly support AD).",
  "timestamp": "2025-07-26T16:42:50.632870"
}