{
  "ptid_time": "127_S_4198_2015-09-29",
  "img_path": "/data/qiuhui/data/adni/images/127_S_4198/2015-09-29/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 45,897 mm³, 24.2% above the reference mean. With a Z-score of 0.65 (74.3th percentile), this represents normal volume ; hippocampal volume measures 6,369 mm³, 1.9% below the reference mean. With a Z-score of -0.16 (43.8th percentile), this represents normal volume ; whole brain volume measures 941,054 mm³, 1.4% above the reference mean. With a Z-score of 0.17 (56.6th percentile), this represents normal volume ; entorhinal cortex volume measures 2,545 mm³, 26.5% below the reference mean. With a Z-score of -1.43 (7.6th percentile), this represents mild atrophy; fusiform gyrus volume measures 16,565 mm³, 2.8% above the reference mean. With a Z-score of 0.21 (58.4th percentile), this represents normal volume ; middle temporal gyrus volume measures 19,447 mm³, 7.9% above the reference mean. With a Z-score of 0.70 (75.8th percentile), this represents normal volume . ",
  "text_data": "Age is 82.4 years. Gender is Female. Education: 16 years. MMSE: 28.0. MoCA: 26.0. Logical Memory: 9.0. APOEε4 alleles: 1.0. Biomarker levels: Amyloid beta: 736.30 pg/mL (normal ); Total tau: 205.50 pg/mL (normal ); Phosphorylated tau: 20.10 pg/mL (normal ). ",
  "true_diagnosis": "Diagnosis: CN.",
  "gpt_diagnosis": "**Reasoning:** The entorhinal cortex shows mild atrophy (Z-score -1.43, 7.6th percentile), which is notable given its role in memory and early Alzheimer's pathology. However, hippocampal and whole brain volumes are normal, CSF biomarkers (Aβ, T-tau, P-tau) are normal, and cognitive scores (MMSE 28, MoCA 26) are intact for age.  \n**Diagnosis:** **CN (Cognitively Normal)**  \n**Confidence:** **Medium** (Isolated entorhinal atrophy could represent very early neurodegeneration, but biomarkers and cognition do not yet support MCI/dementia.)  \n\n---  \n*Key considerations:*  \n- **APOE4 carrier status** increases lifetime AD risk but does not affect current diagnosis.  \n- **Normal CSF biomarkers** strongly argue against active Alzheimer’s pathology.  \n- **Monitor entorhinal changes longitudinally**; if atrophy progresses or cognition declines, reassess for MCI.",
  "timestamp": "2025-07-26T13:15:40.614236"
}