{
  "ptid_time": "123_S_4904_2013-10-10",
  "img_path": "/data/qiuhui/data/adni/images/123_S_4904/2013-10-10/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 50,621 mm³, 126.6% above the reference mean. With a Z-score of 3.17 (99.9th percentile), this represents profound enlargement; hippocampal volume measures 4,637 mm³, 39.7% below the reference mean. With a Z-score of -4.45 (0.0th percentile), this represents profound atrophy; whole brain volume measures 867,125 mm³, 15.7% below the reference mean. With a Z-score of -1.96 (2.5th percentile), this represents moderate atrophy; entorhinal cortex volume measures 2,460 mm³, 36.8% below the reference mean. With a Z-score of -2.85 (0.2th percentile), this represents significant atrophy; fusiform gyrus volume measures 15,029 mm³, 17.5% below the reference mean. With a Z-score of -1.97 (2.5th percentile), this represents moderate atrophy; middle temporal gyrus volume measures 12,764 mm³, 37.8% below the reference mean. With a Z-score of -3.36 (0.0th percentile), this represents profound atrophy. ",
  "text_data": "Age is 66.7 years. Gender is Female. Education: 12 years. MMSE: 27.0. MoCA: 28.0. Logical Memory: 3.0. APOEε4 alleles: 2.0. ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The imaging data shows profound atrophy in key Alzheimer's-related regions (hippocampus, entorhinal cortex, middle temporal gyrus) alongside significant ventricular enlargement, strongly suggestive of neurodegeneration. However, cognitive scores (MMSE 27, MoCA 28) remain in the normal range, indicating a discrepancy between structural and functional decline. APOE4 homozygosity further elevates Alzheimer's risk.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (likely prodromal Alzheimer's given imaging and APOE4 status, but cognitive preservation precludes dementia diagnosis).  \n\n**Confidence:** **Medium** (high confidence in neurodegeneration, but MCI diagnosis is tentative due to intact cognition; follow-up for cognitive decline would strengthen certainty).  \n\n*Note:* If subtle cognitive symptoms are reported but not captured by MMSE/MoCA, \"MCI due to Alzheimer's pathology\" would be more definitive. Clinical correlation is essential.",
  "timestamp": "2025-07-26T12:35:12.536739"
}