{
  "ptid_time": "099_S_6038_2017-09-19",
  "img_path": "/data/qiuhui/data/adni/images/099_S_6038/2017-09-19/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 38,484 mm³, 0.1% below the reference mean. With a Z-score of -0.00 (49.9th percentile), this represents normal volume ; hippocampal volume measures 6,190 mm³, 18.1% below the reference mean. With a Z-score of -1.77 (3.9th percentile), this represents moderate atrophy; whole brain volume measures 949,984 mm³, 12.0% below the reference mean. With a Z-score of -1.56 (6.0th percentile), this represents moderate atrophy; entorhinal cortex volume measures 5,886 mm³, 43.5% above the reference mean. With a Z-score of 2.95 (99.8th percentile), this represents significant enlargement; fusiform gyrus volume measures 16,484 mm³, 12.5% below the reference mean. With a Z-score of -1.06 (14.4th percentile), this represents mild atrophy; middle temporal gyrus volume measures 18,447 mm³, 13.6% below the reference mean. With a Z-score of -1.22 (11.2th percentile), this represents mild atrophy. ",
  "text_data": "Age is 77.4 years. Gender is Male. Education: 16 years. MMSE: 30.0. MoCA: 20.0. Logical Memory: 14.0. APOEε4 alleles: 0.0. Biomarker levels: Florbetapir (AV45): 0.97 SUVR (normal ). ",
  "true_diagnosis": "Diagnosis: CN.",
  "gpt_diagnosis": "**Reasoning:** The hippocampal volume shows moderate atrophy (Z-score -1.77, 3.9th percentile), which is a strong biomarker for Alzheimer's disease (AD). The whole brain and middle temporal gyrus also show mild to moderate atrophy, while the entorhinal cortex is significantly enlarged—an atypical finding that may reflect compensatory mechanisms or measurement variability. The MMSE is normal (30/30), but the MoCA (20/30) suggests cognitive impairment, particularly in executive function, attention, or visuospatial abilities, which is concerning for early neurodegeneration despite the normal amyloid PET (AV45).  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (likely amnestic subtype given hippocampal atrophy, but with atypical entorhinal enlargement).  \n**Confidence:** **Medium** (due to conflicting MoCA/MMSE results and unusual entorhinal cortex enlargement, but hippocampal atrophy strongly supports MCI).  \n\n*Note:* The discrepancy between normal amyloid PET and hippocampal atrophy could suggest non-AD pathology (e.g., hippocampal sclerosis, vascular contributions), but MCI is the most fitting diagnosis at this stage. Further clinical correlation (e.g., CSF biomarkers, FDG-PET) would increase confidence.",
  "timestamp": "2025-07-26T11:11:36.463170"
}