Visualizing brain activation during planning: The Tower of London test adapted for functional MR imaging

BACKGROUND AND PURPOSE: Recent positron emission tomography and single-photon emission CT studies using the Tower of London test have shown that brain activation during planning activities primarily resides in the prefrontal cortex. In this study, we adapted the Tower of London test for functional MR imaging. METHODS: For use with functional MR imaging, a block design of the test was created, in which planning stages were contrasted with counting of colored balls. For nine healthy participants, multisection echo-planar functional MR imaging was performed to assess brain activation based on changes in blood oxygen level. Activation maps for individual participants and a group average map were created. RESULTS: In the group average map, activation in the dorsolateral prefrontal cortex, the anterior part of the cingulate cortex, the cuneus and precuneus, the supramarginal and angular gyrus in the parietal lobe, and the frontal opercular area of the insula was seen. These findings are in agreement with grouped data of previous positron emission tomography results. Functional MR imaging enabled us to investigate brain activation during planning activities with high spatial (and temporal) resolution in individual patients, showing that the dorsolateral prefrontal cortex was activated in all participants studied. CONCLUSION: Presented is a working functional MR imaging version of the planning task. The high sensitivity of functional MR imaging may allow the use of this test for patients with possible (pre)frontal disorders.