{
  "ptid_time": "041_S_4143_2013-08-28",
  "img_path": "/data/qiuhui/data/adni/images/041_S_4143/2013-08-28/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 46,417 mm³, 107.8% above the reference mean. With a Z-score of 2.70 (99.7th percentile), this represents significant enlargement; hippocampal volume measures 5,122 mm³, 33.3% below the reference mean. With a Z-score of -3.74 (0.0th percentile), this represents profound atrophy; whole brain volume measures 911,929 mm³, 11.4% below the reference mean. With a Z-score of -1.42 (7.8th percentile), this represents mild atrophy; entorhinal cortex volume measures 2,032 mm³, 47.8% below the reference mean. With a Z-score of -3.70 (0.0th percentile), this represents profound atrophy; fusiform gyrus volume measures 15,076 mm³, 17.2% below the reference mean. With a Z-score of -1.94 (2.6th percentile), this represents moderate atrophy; middle temporal gyrus volume measures 18,175 mm³, 11.4% below the reference mean. With a Z-score of -1.02 (15.5th percentile), this represents mild atrophy. ",
  "text_data": "Age is 65.6 years. Gender is Female. Education: 19 years. MMSE: 29.0. MoCA: 23.0. Logical Memory: 2.0. APOEε4 alleles: 0.0. Biomarker levels: Florbetapir (AV45): 1.05 SUVR (normal ); Total tau: 271.80 pg/mL (normal ); Phosphorylated tau: 22.06 pg/mL (normal ). ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The imaging data shows profound atrophy in the hippocampus and entorhinal cortex, which are key regions affected in Alzheimer's disease (AD), along with significant ventricular enlargement and moderate-to-mild atrophy in other temporal lobe structures. Despite normal CSF biomarkers (T-tau, P-tau, AV45) and no APOE4 risk allele, the MoCA score of 23 suggests mild cognitive impairment (MCI), while the preserved MMSE (29) may reflect its lower sensitivity to early AD.  \n\n**Diagnosis:** **MCI** (likely due to underlying AD pathology given the hippocampal/entorhinal atrophy, but biomarker discordance lowers certainty).  \n\n**Confidence:** **Medium** (high confidence in MCI based on MoCA and imaging, but low confidence in etiology due to normal biomarkers and lack of APOE4).  \n\n*Note: A follow-up amyloid PET or repeat cognitive testing in 6–12 months would help clarify progression to dementia.*",
  "timestamp": "2025-07-26T07:13:59.870415"
}