{
  "ptid_time": "035_S_4114_2011-07-15",
  "img_path": "/data/qiuhui/data/adni/images/035_S_4114/2011-07-15/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 21,876 mm³, 17.5% above the reference mean. With a Z-score of 0.50 (69.1th percentile), this represents normal volume ; hippocampal volume measures 7,676 mm³, 1.7% below the reference mean. With a Z-score of -0.23 (40.7th percentile), this represents normal volume ; whole brain volume measures 1,072,220 mm³, 3.0% above the reference mean. With a Z-score of 0.37 (64.2th percentile), this represents normal volume ; entorhinal cortex volume measures 3,791 mm³, 2.6% above the reference mean. With a Z-score of 0.20 (58.0th percentile), this represents normal volume ; fusiform gyrus volume measures 16,525 mm³, 10.3% below the reference mean. With a Z-score of -0.94 (17.4th percentile), this represents normal volume ; middle temporal gyrus volume measures 22,760 mm³, 10.8% above the reference mean. With a Z-score of 0.89 (81.5th percentile), this represents normal volume . ",
  "text_data": "Age is 55.0 years. Gender is Female. Education: 14 years. Handedness: Right. Race: White. Medical history: Musculoskeletal; Allergies or Drug Sensitivities; Smoking; Major Surgical Procedures. MMSE: 28.0. MoCA: 24.0. Logical Memory: 4.0. Laboratory findings: . APOEε4 alleles: 1.0. Biomarker levels: Florbetapir (AV45): 1.21 SUVR (mild elevated); Amyloid beta: 916.10 pg/mL (normal ); Total tau: 525.10 pg/mL (profound elevated); Phosphorylated tau: 47.82 pg/mL (profound elevated). ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The brain volume measurements are largely within normal ranges, with only the fusiform gyrus showing a mild reduction (10.3% below mean, Z-score -0.94). However, the CSF biomarkers (profoundly elevated T-tau and P-tau, mild Aβ elevation on AV45 PET) suggest underlying Alzheimer's pathology despite normal Aβ in CSF. The MMSE (28) is normal, but the MoCA (24) indicates possible mild cognitive impairment.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)**, likely due to Alzheimer’s pathology (biomarker evidence of tauopathy with minimal Aβ abnormality).  \n\n**Confidence:** **Medium** (biomarkers strongly suggest neurodegeneration, but cognitive scores are borderline, and structural atrophy is not yet pronounced).",
  "timestamp": "2025-07-26T05:54:39.724580"
}