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After suffering traumatic brain injury(TBI), there may be a substantial number of disabled people whose impairment is not recognized socially because their disabilities are limited to cognitive, emotional and behavioral domains, with no obvious physical deficits. The Japanese Government has provided medico-social services for such patients diagnosed with impairments of executive brain function(IEBF), since 2006. One of the administrative criteria for diagnosis of IEBF to receive medico-social services is the confirmation of organic injured lesions in the brain by neuroimaging modalities. Consequently, some people with chronic stage TBI have been excluded from receiving services because no lesions were apparent on conventional CT or MRI. Recent development of SPECT, PET and new MRI neuroimaging modalities make it possible to detect regions of metabolic dysfunction where organic injured lesions may be absent or have not been detected on conventional CT or MRI. One of the most crucial diagnostic findings of diffuse TBI in the chronic stage on conventional CT or MRI is diffuse brain atrophy. T2 weighted imaging(WI)and susceptibility WI(SWI)are extremely sensitive methods to detect hemosiderin-lading lesions even in the chronic stage. Another method, diffusion tensor imaging(DTI), permits the evaluation of white matter structural integrity in the brain. One index used in DTI is the fractional anisotropy(FA)value. A region of interest(ROI)study of FA values in patients with diffuse TBI revealed significant decreases in the corpus callosum, coronal radiation, centrum semiovale, cingulated gyrus. Tractogram derived by fiber tracking on FA map is an innovative neuroimaging technique, which reveals axonal deficits visually. Another innovative neuroimaging tool derived from DTI is the FA-SPM image. This permits the detection of lesions with significantly decreased FA values objectively and over the whole brain. Alternatively, FDGPET and ECD-SPECT are functional neuroimaging modalities which can uncover the regions with metabolic dysfunction in the brain. In patients with diffuse TBI, metabolic dysfunction is characteristically shown in the medial part of the prefrontal region and the base of the bilateral frontal lobes, the bilateral cingulated gyri, and the bilateral thalami, in the chronic stage. The findings suggesting the existence of minute lesions due to TBI on these new neuroimaging modalities may be useful evidence for diagnosing IEBF administratively, and also serve as a tool for elucidating the mechanisms of IEBF after TBI. (Received May 15, 2013;accepted May 17, 2013)

Neuroimaging of Patients with Impairments of Executive Brain Function Due to Traumatic Brain Injury