{
  "ptid_time": "002_S_4237_2011-09-26",
  "img_path": "/data/qiuhui/data/adni/images/002_S_4237/2011-09-26/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 92,447 mm³, 150.1% above the reference mean. With a Z-score of 4.05 (100.0th percentile), this represents profound enlargement; hippocampal volume measures 6,102 mm³, 6.1% below the reference mean. With a Z-score of -0.48 (31.4th percentile), this represents normal volume ; whole brain volume measures 976,304 mm³, 5.2% above the reference mean. With a Z-score of 0.62 (73.3th percentile), this represents normal volume ; entorhinal cortex volume measures 3,915 mm³, 13.1% above the reference mean. With a Z-score of 0.71 (76.0th percentile), this represents normal volume ; fusiform gyrus volume measures 16,367 mm³, 1.6% above the reference mean. With a Z-score of 0.12 (54.8th percentile), this represents normal volume ; middle temporal gyrus volume measures 18,784 mm³, 4.2% above the reference mean. With a Z-score of 0.37 (64.5th percentile), this represents normal volume . ",
  "text_data": "Age is 80.9 years. Gender is Female. Education: 13 years. Handedness: Right. Race: White. Medical history: Neurologic; Head, Eyes, Ears, Nose and Throat; Cardiovascular; Musculoskeletal; Endocrine-Metabolic; Allergies or Drug Sensitivities; Smoking; Major Surgical Procedures. MMSE: 29.0. MoCA: 23.0. Logical Memory: 6.0. Laboratory findings: Basophils: 0.09 (significant elevated); Basophils: 1.50 (significant elevated); Total Protein: 6.20 (significant reduced); Albumin: 3.40 (significant reduced). APOEε4 alleles: 0.0. Biomarker levels: Florbetapir (AV45): 0.99 SUVR (normal ); Total tau: 302.10 pg/mL (normal ); Phosphorylated tau: 25.66 pg/mL (normal ). ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The patient shows profound ventricular enlargement (Z-score 4.05), which is strongly suggestive of significant brain atrophy, particularly in the context of normal hippocampal and other regional volumes. Despite normal CSF biomarkers (T-tau, P-tau, AV45) and no APOE4 risk allele, the MoCA score of 23 (borderline for MCI) and age of 80.9 raise concerns. The MMSE of 29 is within normal limits, but ventricular enlargement is a red flag for neurodegenerative processes.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)**  \n**Confidence:** **Medium** (due to conflicting markers—ventricular enlargement vs. normal biomarkers and mostly preserved cognitive scores)",
  "timestamp": "2025-07-25T20:24:32.612828"
}