{
  "ptid_time": "133_S_0913_2007-01-18",
  "img_path": "/data/qiuhui/data/adni/images/133_S_0913/2007-01-18/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 42,129 mm³, 126.2% above the reference mean. With a Z-score of 3.61 (100.0th percentile), this represents profound enlargement; hippocampal volume measures 4,777 mm³, 38.8% below the reference mean. With a Z-score of -5.40 (0.0th percentile), this represents profound atrophy; whole brain volume measures 845,653 mm³, 18.7% below the reference mean. With a Z-score of -2.25 (1.2th percentile), this represents significant atrophy; entorhinal cortex volume measures 2,538 mm³, 31.3% below the reference mean. With a Z-score of -2.45 (0.7th percentile), this represents significant atrophy; fusiform gyrus volume measures 13,206 mm³, 28.4% below the reference mean. With a Z-score of -2.57 (0.5th percentile), this represents significant atrophy; middle temporal gyrus volume measures 10,472 mm³, 49.0% below the reference mean. With a Z-score of -4.04 (0.0th percentile), this represents profound atrophy. ",
  "text_data": "Age is 56.6 years. Gender is Female. Education: 15 years. MMSE: 26.0. Logical Memory: 3.0. APOEε4 alleles: 0.0. Biomarker levels: Amyloid beta: 701.40 pg/mL (normal ); Total tau: 225.70 pg/mL (normal ); Phosphorylated tau: 23.84 pg/mL (normal ). ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The imaging data shows profound atrophy in key Alzheimer's-related regions (hippocampus, middle temporal gyrus) and significant whole-brain atrophy, alongside ventricular enlargement, suggesting advanced neurodegeneration. However, cognitive testing (MMSE 26) is only mildly impaired, and CSF biomarkers (Aβ, T-tau, P-tau) are normal, which is atypical for Alzheimer’s pathology.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (non-amnestic or non-AD subtype given biomarker profile).  \n**Confidence:** **Medium** (high confidence in neurodegeneration but low confidence in etiology due to normal biomarkers and discordant clinical severity).  \n\n*Note:* The discrepancy between structural damage and preserved cognition/biomarkers raises the possibility of a non-AD neurodegenerative process (e.g., FTD, vascular pathology) or an atypical presentation. Further workup (e.g., FDG-PET, tau-PET, vascular imaging) would be needed.",
  "timestamp": "2025-07-26T15:28:14.728318"
}