{
  "ptid_time": "032_S_6279_2019-06-27",
  "img_path": "/data/qiuhui/data/adni/images/032_S_6279/2019-06-27/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 64,253 mm³, 31.5% above the reference mean. With a Z-score of 2.85 (99.8th percentile), this represents significant enlargement; hippocampal volume measures 5,724 mm³, 10.1% below the reference mean. With a Z-score of -1.10 (13.5th percentile), this represents mild atrophy; whole brain volume measures 973,694 mm³, 2.8% below the reference mean. With a Z-score of -0.48 (31.7th percentile), this represents normal volume ; entorhinal cortex volume measures 2,847 mm³, 28.0% below the reference mean. With a Z-score of -1.44 (7.5th percentile), this represents mild atrophy; fusiform gyrus volume measures 13,880 mm³, 17.6% below the reference mean. With a Z-score of -2.04 (2.1th percentile), this represents significant atrophy; middle temporal gyrus volume measures 16,503 mm³, 12.5% below the reference mean. With a Z-score of -1.91 (2.8th percentile), this represents moderate atrophy. ",
  "text_data": "Age is 90.1 years. Gender is Male. Education: 20 years. MMSE: 28.0. MoCA: 19.0. Logical Memory: 7.0. APOEε4 alleles: 0.0. ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The imaging data shows significant ventricular enlargement (consistent with atrophy) and mild-to-moderate atrophy in key Alzheimer’s-related regions (hippocampus, entorhinal cortex, fusiform gyrus, middle temporal gyrus). Despite the high MMSE (28), the MoCA (19) suggests cognitive impairment, which, combined with the structural changes, is concerning for neurodegeneration. The absence of APOE4 does not rule out Alzheimer’s, especially at this age.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (likely amnestic subtype given hippocampal/entorhinal atrophy, but MoCA deficits suggest broader impairment).  \n\n**Confidence:** **Medium** (high confidence in neurodegeneration, but MCI vs. early dementia is less clear due to the discrepancy between MMSE and MoCA).  \n\n*Note:* Given the age (90.1), some atrophy is expected, but the extent (especially fusiform/middle temporal) and MoCA score suggest pathological progression. Follow-up clinical correlation (e.g., neuropsychological testing for memory/executive function) would strengthen certainty.",
  "timestamp": "2025-07-26T05:08:41.887261"
}