{
  "ptid_time": "018_S_0142_2009-02-11",
  "img_path": "/data/qiuhui/data/adni/images/018_S_0142/2009-02-11/t1.nii.gz",
  "img_finding": "Image findings: ventricular volume measures 50,505 mm³, 7.4% above the reference mean. With a Z-score of 0.22 (58.5th percentile), this represents normal volume ; hippocampal volume measures 5,571 mm³, 20.1% below the reference mean. With a Z-score of -1.73 (4.2th percentile), this represents moderate atrophy; whole brain volume measures 927,510 mm³, 9.9% below the reference mean. With a Z-score of -1.29 (9.8th percentile), this represents mild atrophy; entorhinal cortex volume measures 4,824 mm³, 21.5% above the reference mean. With a Z-score of 1.41 (92.1th percentile), this represents mild enlargement; fusiform gyrus volume measures 15,853 mm³, 12.2% below the reference mean. With a Z-score of -1.06 (14.4th percentile), this represents mild atrophy; middle temporal gyrus volume measures 16,802 mm³, 16.7% below the reference mean. With a Z-score of -1.50 (6.7th percentile), this represents mild atrophy. ",
  "text_data": "Age is 82.2 years. Gender is Male. Education: 14 years. MMSE: 30.0. Logical Memory: 7.0. APOEε4 alleles: 1.0. ",
  "true_diagnosis": "Diagnosis: MCI.",
  "gpt_diagnosis": "**Reasoning:** The patient shows significant hippocampal atrophy (Z-score -1.73, 4.2th percentile) and mild-to-moderate atrophy in other temporal lobe structures (fusiform gyrus, middle temporal gyrus), which are hallmark features of Alzheimer's pathology. However, cognitive performance (MMSE 30/30) remains intact, suggesting preclinical or very early-stage disease. The presence of one APOE4 allele increases Alzheimer's risk.  \n\n**Diagnosis:** **Mild Cognitive Impairment (MCI)** (likely prodromal Alzheimer’s given biomarker profile, though cognition is still normal).  \n**Confidence:** **Medium** (high confidence in neurodegeneration markers, but clinical diagnosis is uncertain due to preserved MMSE).  \n\n*Note: Given the structural atrophy pattern, this patient is at high risk of progressing to dementia, but current MMSE does not yet meet criteria. Close monitoring is warranted.*",
  "timestamp": "2025-07-26T00:44:49.117189"
}