{
  "ptid_time": "137_S_4303_2011-11-02",
  "img_path": "/data/qiuhui/data/adni/images/137_S_4303/2011-11-02/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 46,668 mm³, 26.3% above the reference mean. With a Z-score of 0.71 (76.1th percentile), this represents normal volume ; hippocampal volume measures 5,210 mm³, 19.8% below the reference mean. With a Z-score of -1.59 (5.6th percentile), this represents moderate atrophy; whole brain volume measures 979,251 mm³, 5.5% above the reference mean. With a Z-score of 0.66 (74.5th percentile), this represents normal volume ; entorhinal cortex volume measures 2,935 mm³, 15.2% below the reference mean. With a Z-score of -0.82 (20.5th percentile), this represents normal volume ; fusiform gyrus volume measures 14,179 mm³, 12.0% below the reference mean. With a Z-score of -0.90 (18.4th percentile), this represents normal volume ; middle temporal gyrus volume measures 19,285 mm³, 7.0% above the reference mean. With a Z-score of 0.62 (73.2th percentile), this represents normal volume . ",
  "text_data": "Age is 80.2 years. Gender is Female. Education: 20 years. Handedness: Right. Race: White. Medical history: Head, Eyes, Ears, Nose and Throat; Cardiovascular; Musculoskeletal; Endocrine-Metabolic; Allergies or Drug Sensitivities; Smoking; Major Surgical Procedures. MMSE: 30.0. MoCA: 22.0. Logical Memory: 1.0. Laboratory findings: . APOEε4 alleles: 1.0. Biomarker levels: Florbetapir (AV45): 1.82 SUVR (profound elevated); Amyloid beta: 668.70 pg/mL (normal ); Total tau: 258.60 pg/mL (normal ); Phosphorylated tau: 24.99 pg/mL (normal ). ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The hippocampal volume shows moderate atrophy (Z-score -1.59, 5.6th percentile), which is a strong biomarker for Alzheimer's disease (AD), while other brain regions are within normal ranges. The MMSE is normal (30/30), but the MoCA (22/30) suggests mild cognitive impairment (MCI). Despite normal CSF biomarkers (Aβ, T-tau, P-tau), the profoundly elevated AV45 (amyloid PET) indicates significant amyloid deposition, a hallmark of AD.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI) due to Alzheimer’s disease** (given hippocampal atrophy, amyloid positivity, and MoCA <26).  \n\n**Confidence:** **High** (due to clear hippocampal atrophy, amyloid PET positivity, and MoCA impairment despite normal MMSE).  \n\n*Note: The discrepancy between CSF (normal) and AV45 (elevated) may reflect early amyloid deposition not yet reflected in CSF, or a CSF false negative (less likely). The diagnosis leans toward MCI-AD given imaging and cognitive findings.*",
  "timestamp": "2025-07-26T16:30:04.485656"
}