{
  "ptid_time": "168_S_6821_2020-12-18",
  "img_path": "/data/qiuhui/data/adni/images/168_S_6821/2020-12-18/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 35,296 mm³, 25.8% above the reference mean. With a Z-score of 0.59 (72.2th percentile), this represents normal volume ; hippocampal volume measures 6,000 mm³, 15.7% below the reference mean. With a Z-score of -1.44 (7.5th percentile), this represents mild atrophy; whole brain volume measures 818,185 mm³, 16.1% below the reference mean. With a Z-score of -2.02 (2.2th percentile), this represents significant atrophy; entorhinal cortex volume measures 6,207 mm³, 69.0% above the reference mean. With a Z-score of 4.23 (100.0th percentile), this represents profound enlargement; fusiform gyrus volume measures 13,631 mm³, 19.9% below the reference mean. With a Z-score of -1.81 (3.5th percentile), this represents moderate atrophy; middle temporal gyrus volume measures 16,187 mm³, 15.6% below the reference mean. With a Z-score of -1.35 (8.8th percentile), this represents mild atrophy. ",
  "text_data": "Age is 72.7 years. Gender is Female. Education: 16 years. MMSE: 30.0. MoCA: 22.0. Logical Memory: 11.0. APOEε4 alleles: 1.0. ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The patient exhibits significant whole brain atrophy (Z-score -2.02) and mild-to-moderate atrophy in key Alzheimer’s-related regions (hippocampus, fusiform gyrus, middle temporal gyrus), alongside a paradoxically enlarged entorhinal cortex (Z-score +4.23). Despite normal MMSE (30), the MoCA (22) suggests mild cognitive impairment. APOE4 positivity increases Alzheimer’s risk.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (likely prodromal Alzheimer’s given biomarker profile).  \n**Confidence:** **Medium** (atypical entorhinal enlargement warrants caution, but other atrophy patterns and MoCA strongly suggest MCI).  \n\n*Note:* The entorhinal cortex enlargement is highly unusual for Alzheimer’s and may indicate measurement artifact or a rare variant (e.g., inflammatory/compensatory changes). Further clinical correlation (e.g., CSF biomarkers, FDG-PET) would strengthen confidence.",
  "timestamp": "2025-07-26T17:23:31.416677"
}