Checklist and Scoring System for the Assessment of Soft Tissue Preservation in CT Examinations of Human Mummies

Preservation of the heart in ancient Egyptian mummies: A computed tomography investigation with focus on the myocardium

The ancient Egyptians considered the heart to be the most important organ. The belief that the heart remained in the body is widespread in the archeological and paleopathological literature. The purpose of this study was to perform an overview of the preserved intrathoracic structures and thoracic and abdominal cavity filling, and to determine the prevalence and computed tomography (CT) characteristics of the myocardium in the preserved hearts of ancient Egyptian mummies. Whole-body CT examinations of 45 ancient Egyptian mummies (23 mummies from the Ägyptisches Museum und Papyrussammlung, Berlin, Germany, and 22 mummies from the Museo Egizio, Turin, Italy) were systematically assessed for preserved intrathoracic soft tissues including various anatomical components of the heart (pericardium, interventricular septum, four chambers, myocardium, valves). Additionally, evidence of evisceration and cavity filling was documented. In cases with identifiable myocardium, quantitative (measurements of thickness and density) and qualitative (description of the structure) assessment of the myocardial tissue was carried out. Heart structure was identified in 28 mummies (62%). In 33 mummies, CT findings demonstrated evisceration, with subsequent cavity filling in all but one case. Preserved myocardium was identified in nine mummies (five male, four female) as a mostly homogeneous, shrunken structure. The posterior wall of the myocardium had a mean maximum thickness of 3.6 mm (range 1.4-6.6 mm) and a mean minimum thickness of 1.0 mm (range 0.5-1.7 mm). The mean Hounsfield units (HU) of the myocardium at the posterior wall was 61 (range, 185-305). There was a strong correlation between the HU of the posterior wall of the myocardium and the mean HU of the muscles at the dorsal humerus (R = 0.77; p = 0.02). In two cases, there were postmortem changes in the myocardium, most probably due to insect infestation. To our knowledge, this is the first study to investigate the myocardium systematically on CT scans of ancient Egyptian mummies. Strong correlations between the densities of the myocardium and skeletal muscle indicated similar postmortem changes of the respective musculature during the mummification process within individual mummies. The distinct postmortem shrinking of the myocardium and the collapse of the left ventriclular cavity in several cases did not allow for paleopathological diagnoses such as myocardial scarring.

Radiological evidence of purulent infections in ancient Egyptian child mummies

OBJECTIVE

To identify computed tomography (CT) findings of purulent infections in ancient Egyptian child mummies.

MATERIALS

Whole-body CT examination of 21 ancient Egyptian child mummies from German (n = 18), Italian (n = 1), and Swiss museums (n = 2).

METHODS

CT examinations were evaluated for estimation of age at death and sex of the children. CT examinations were systematically assessed for any CT findings of purulent infection.

RESULTS

The estimated age at death of the children ranged from about one year to the age of 12-14 years (mean 4.8 years). Twelve children were assessed as male, seven as female and in two sex was indeterminate. Three out of 21 child mummies (14.3%) had radiological evidence of purulent infections. In one mummy, a bandage-like structure at the right lower leg was detected that most likely represented a dressing of a skin lesion.

CONCLUSIONS

This study appears to be the first to describe radiologically visualized structures consistent with dried pus in ancient Egyptian mummies. This study also appears to be the first to physically demonstrate an original ancient Egyptian dressing.

SIGNIFICANCE

These cases may serve as models for further paleopathological investigation. The evidence of an original dressing contributes to our knowledge of ancient Egyptian medicine.

LIMITATIONS

CT was used as the only examination method as sampling of the wrapped mummies was not possible.

SUGGESTIONS FOR FURTHER RESEARCH

Radiological-pathological correlation in mummies in which physical sampling is available may reveal further insights into purulent infections in ancient Egypt.

Correlation of atherosclerosis and osteoarthritis in ancient Egypt: A standardized evaluation of 45 whole-body CT examinations

OBJECTIVE

To correlate atherosclerosis (Ath) and osteoarthritis (OA) in mummies from ancient Egypt.

MATERIALS

Whole-body CT examinations of 23 mummies from the Ägyptisches Museum und Papyrussammlung, Berlin, Germany, and 22 mummies from the Museo Egizio, Turin, Italy.

METHODS

Ath was assessed in five anatomical regions by means of preserved arterial calcifications. OA was assessed using the Kellgren and Lawrence (1957) classification.

RESULTS

Statistical analysis revealed no correlation between Ath and total OA. A significant association was found for Ath and the upper limb group for OA grade >1 and for Ath and the lower limb group, consisting mainly of the hip and knee, for OA grade >2 OA.

CONCLUSIONS

The association of Ath and advanced OA of the hip and knee is comparable in prevalence to those reported in recent clinical studies, despite the low life expectancy and the different environment and lifestyle of the ancient Egyptians.

SIGNIFICANCE

This is the first study to correlate findings of Ath and OA in ancient Egypt statistically. The diseases of Ath and OA are common ailments with enormous and increasing impacts on public health.

LIMITATIONS

The large number of cardiovascular diseases was indicated only by arterial calcifications that resisted the post-mortem changes of the mummification process. Also, the assessed OA was on radiological OA.

SUGGESTIONS FOR FURTHER RESEARCH

Genomic studies of ancient Egyptian mummies may reveal genetic risk factors for Ath and OA that could be shared in ancient and modern populations.

Chronic active non-lethal human-type tuberculosis in a high royal Bavarian officer of Napoleonic times-a mummy study

In paleopathology, morphological and molecular evidence for infection by mycobacteria of the M. tuberculosis complex (MTC) is frequently associated with early death. In the present report, we describe a multidisciplinary study of a well-preserved mummy from Napoleonic times with a long-standing tuberculous infection by M. tuberculosis senso stricto who died at the age of 88 years of focal and non-MTB related bronchopneumonia. The well-preserved natural mummy of the Royal Bavarian General, Count Heinrich LII Reuss-Köstritz (1763–1851 CE), was extensively investigated by macro- and histomorphology, whole body CT scans and organ radiography, various molecular tissue analyses, including stable isotope analysis and molecular genetic tests. We identified signs for a long-standing, but terminally inactive pulmonary tuberculosis, tuberculous destruction of the second lumbar vertebral body, and a large tuberculous abscess in the right (retroperitoneal) psoas region (a cold abscess). This cold abscess harboured an active tuberculous infection as evidenced by histological and molecular tests. Radiological and histological analysis further revealed extensive arteriosclerosis with (non-obliterating) coronary and significant carotid arteriosclerosis, healthy bone tissue without evidence of age-related osteopenia, evidence for diffuse idiopathic skeletal hyperostosis and mild osteoarthrosis of few joints. This suggests excellent living conditions correlating well with his diet indicated by stable isotope results and literary evidence. Despite the clear evidence of a tuberculous cold abscess with bacterioscopic and molecular proof for a persisting MTC infection of a human-type M. tuberculosis strain, we can exclude the chronic MTC infection as cause of death. The detection of MTC in historic individuals should therefore be interpreted with great caution and include further data, such as their nutritional status.

Decorated bodies for eternal life: A multidisciplinary study of late Roman Period stucco-shrouded portrait mummies from Saqqara (Egypt)

This study focuses on the multidisciplinary investigation of three stucco-shrouded mummies with mummy portrait from Egypt dating from the late 3^rd to the middle of the 4^th century AD, corresponding to the late Roman Period. These three mummies were excavated in the early 17^th and late 19^th centuries in the Saqqara necropolis near the ancient Egyptian capital of Memphis. Two of them experienced an interesting collection history, when they became part of the collection of the Elector of Saxony and King of Poland August II in Dresden, Germany, in 1728. The investigation includes information about the mummies’ discovery, collection history and shroud decoration obtained through Egyptological expertise. In addition, information on the state of preservation, technique of artificial mummification, age at death, sex, body height and health of the deceased was achieved through computed tomography (CT) analysis. Research yielded an adult male, a middle-aged female and a young female. Due to the rather poorly preserved bodies of the male and middle-aged female, a specific technique of artificial mummification could not be ascertained. Brain and several internal organs of the well-preserved young female were identified. Wooden boards, beads of necklaces, a hairpin, and metal dense items, such as lead seals, nails and two coins or medallions were discovered. Paleopathological findings included carious lesions, Schmorl’s nodes, evidence of arthritis and a vertebral hemangioma. The study revealed insights on the decoration and burial preparation of individuals of upper socioeconomic status living in the late Roman Period, as well as comprehensive bioanthropological information of the deceased.

The iliosacral joint in lizards: an osteological and histological analysis

The development of the iliosacral joint (ISJ) in tetrapods represented a crucial step in the evolution of terrestrial locomotion. This structure is responsible for transferring forces between the vertebral column and appendicular skeleton, thus supporting the bodyweight on land. However, most research dealing with the water-to-land transition and biomechanical studies in general has focused exclusively on the articulation between the pelvic girdle and femur. Our knowledge about the contact between the pelvic girdle and vertebral column (i.e. the ISJ) at a tissue level is restricted so far to human anatomy, with little to no information available on other tetrapods. This lack of data limits our understanding of the development and evolution of such a key structure, and thus on the pattern and processes of the evolution of terrestrial locomotion. Therefore, we investigated the macro- and microanatomy of the ISJ in limb-bearing squamates that, similar to most non-mammalian, non-avian tetrapods, possess only two sacral ribs articulating with the posterior process of the ilium. Using a combination of osteology, micro-computed tomography and histology, we collected data on the ISJ apparatus of numerous specimens, sampling different taxa and different ontogenetic stages. Osteologically, we recorded consistent variability in all three processes of the ilium (preacetabular, supracetabular and posterior) and sacral ribs that correlate with posture and locomotion. The presence of a cavity between the ilium and sacral ribs, abundant articular cartilage and fibrocartilage, and a surrounding membrane of dense fibrous connective tissue allowed us to define this contact as a synovial joint. By comparison, the two sacral ribs are connected to each other mostly by dense fibrous tissue, with some cartilage found more distally along the margins of the two ribs, defining this joint as a combination of a syndesmosis and synchondrosis. Considering the intermediary position of the ISJ between the axial and appendicular skeletons, the shape of the articular surfaces of the sacral ribs and ilium, and the characteristics of the muscles associated with this structure, we argue that the mobility of the ISJ is primarily driven by the movements of the hindlimb during locomotion. We hypothesize that limited torsion of the ilium at the ISJ happens when the hip is abducted, and the joint is likely able to absorb the compressional and extensional forces related to the protraction and retraction of the femur. The mix of fibres and cartilage between the two sacral ribs instead serves primarily as a shock absorber, with the potential for limited vertical translation during locomotion.

How to CT scan human mummies: Theoretical considerations and examples of use

OBJECTIVE

The purpose of this study was to develop and provide recommendations for computed tomography (CT) examinations of human mummies.

MATERIALS AND METHODS

Based on theoretical considerations and examples, recommendations for use are provided for scanning and image reconstruction parameters. Four examples are presented to illustrate the effect of different CT parameters on image quality.

RESULTS

The use of appropriate scanning parameters (detector collimation, pitch factor, rotation time) is known to improve image quality; technical considerations favor using lower tube voltage and higher tube current values for the purposes of scanning of human mummies. The use of appropriate image reconstruction parameters (slice thickness, increment, field of view, reconstruction filters) are the basis for individual reconstructions for the purpose of evaluation, documentation, illustration and data storage.

CONCLUSIONS

Downsizing the field of view to the region of interest as done in the clinical radiological routine represents one major tool to improve image quality.

SIGNIFICANCE

The provided recommendations should improve CT image quality in mummy studies as well as the handling of image data for reconstructions and storage.

LIMITATIONS

The recommendations for CT scanning parameters and image reconstructions were written with relatively new generation CT scanners in mind. Only a few examples of use were chosen and image quality assessment was performed subjectively and not by quantitative measurements.

Diagnosis by consensus: A case study in the importance of interdisciplinary interpretation of mummified remains

OBJECTIVE

The goal of this study is to demonstrate the need for interdisciplinary consensus and inclusion of mummy radiology specialists in analyses of mummified remains.

MATERIALS

This study uses paleoimaging data for an ancient Egyptian mummy at the Museum of Human Anatomy "Filippo Civinini".

METHODS

This study demonstrates the benefit of evaluation of mummified remains in a multi-disciplinary interpretive team.

RESULTS

The authors propose a diagnosis of DISH, additional signs of undifferentiated spondyloarthropathy, and lumbarisation of S1.

CONCLUSIONS

The process of diagnosis by consensus is essential to the analysis of mummified remains, which are complexly altered through natural and anthropogenic processes in the millennia subsequent to the individual's death.

SIGNIFICANCE

Mummy paleoimaging and paleopathology lacks a unifying set of standards. We present an example of the value to be found in the multi-disciplinary diagnosis by consensus approach.

LIMITATIONS

We discuss numerous challenges to accurate and meaningful interpretation that radiography of mummified remains pose.

SUGGESTIONS FOR FURTHER RESEARCH

While the authors do not seek to impose any single set of standards, we do recommend a larger discussion on the topic of (culture-specific) standardisation in mummy paleoimaging and paleopathology. We further recommend the development of an international, multi-disciplinary panel of paleoimaging interpreters.

Evaluation of lesion burden in a bone-by-bone comparison of osteological and radiological methods of analysis

OBJECTIVE

To evaluate differences in lesion identification in skeletal remains with respect to bone type and method of analysis.

MATERIALS

212 mostly 19th century adult skeletons from St. Bride's Church in London.

METHODS

Using a standard protocol, an osteologist evaluated each set of remains for lesions. A radiologist used the same system to examine radiographs of the crania, humeri, pelves, tibiae, and femora.

RESULTS

Osteological analysis noted more lesions per bone type. All bone types examined showed positive, statistically significant correlations between the number of lesions identified by each analytical method. The humerus, tibia, and femur exhibited the strongest correlations. The pelvis exhibited the weakest correlation. For the cranium and pelvis, males showed stronger correlations.

CONCLUSIONS

Sex-related differences in correlations were likely influenced by the presence, in females, of lesions affecting the entire skeleton (e.g., osteoporosis). Greater correlations between analytical modalities were observed for long bones.

SIGNIFICANCE

Our findings quantify the contexts in which radiological and osteological evaluations converge and diverge and discuss the implications of these results for lesion burden interpretation.

LIMITATIONS

Generalizability, potential subjectivity of evaluative methods.

SUGGESTIONS FOR FURTHER RESEARCH

Assessment of another study collection using the same methods, to determine if the similar correlations are observed.

Evidence of aortic dissection and Marfan syndrome in a mummy from the Capuchin Catacombs of Palermo, Sicily

The authors report on the assessment of an anthropogenic mummy of a young man from the Capuchin Catacombs of Palermo, Sicily, tentatively dated from the mid- to late 19^th century AD. The mummy was investigated by full-body CT examination. CT images clearly showed aortic dissection classified as Stanford-A. Due to the relation of aortic dissection to inherited connective tissue diseases in young people, such as Marfan syndrome, conspicuous and pathological findings possibly indicating the presence of underlying Marfan syndrome were assessed. Several systemic features were scored that supported the presence of underlying Marfan syndrome in this mummy. These findings were: pectus carinatum and chest asymmetry, dural ectasia, protrusio acetabuli, dolichocephaly, down-slanting palpebral fissures, malar hypoplasia and (probable) reduced elbow extension. Aortic dissection, a cardinal feature of Marfan syndrome, turned out to be the diagnostic key for the paleoradiological diagnosis of this disease. The demonstrated CT findings contribute to the spectrum of cardiovascular diseases and inherited connective tissue disease in the fields of paleopathology and paleoradiology.

CT checklist and scoring system for the assessment of soft tissue preservation in human mummies: application to catacomb mummies from Palermo, Sicily

In this study we applied the recently developed "Checklist and Scoring System for the Assessment of Soft Tissue Preservation in Human Mummies" to catacomb mummies from Palermo, Sicily. Data from twenty-three full-body computed tomography (CT) examinations were available. These consisted of seventeen adults and six children dating from the late 18th to the late 19th centuries AD. Seventeen of these mummies were anthropogenically mummified, and six spontaneously. Based on the checklist and scoring system, soft tissue preservation varied between both mummification groups, among mummies with the same type of mummification, and within individual mummies at different anatomical locations. Checkpoints of the main category "A. Soft Tissues of Head and Musculoskeletal System" were clearly more frequent than checkpoints of the main category "B. Organs and Organ Systems". Among the anthropogenic mummies, intra-arterial filling achieved the highest preservation status of organs and organ systems. Despite the small sample size, the statistical evaluation showed significant differences between mummification types, with the highest soft tissue preservation found in anthropogenic mummies. Application of the "Checklist" allowed a standardized assessment and documentation of the soft tissue preservation of these mummies. The "Scoring System" facilitated a comparison among mummification groups and mummies by means of numeric values.

Digital data recording and interpretational standards in mummy science

Beginning during the late19th century, paleoimaging has played an ever-expanding role in mummy science. Increasingly during the 21st century, digital radiographic data collected through imaging efforts have become significant. The rapid influx of imaging data raises questions regarding standardized approaches to both acquisition and interpretation. Reports using digital data presented without contextual considerations commonly lead to interpretational errors. Digital data recording and interpretation require rigorous methodology and standards in order to achieve reproducibility, accuracy and minimization of inter- and intra-observer error. Researchers applying paleoimaging methods in bioarchaeological research must understand the significant limitations inherent in data collection and interpretation from various digital data recording methods. Currently, vast amounts of digital data are being archived, allowing greater potential for hypothesis-based research and informed diagnosis by consensus. Digital databases hold great potential in preparing both radiologists and bioarchaeologists in the appropriate application and interpretation of digital data.

The Sommersdorf mummies-An interdisciplinary investigation on human remains from a 17th-19th century aristocratic crypt in southern Germany

Sommersdorf Castle (Bavaria, Germany) is a medieval castle complex which has been inhabited by the aristocratic family von Crailsheim. The deceased were entombed in a crypt located in the parapets underneath the castle’s church, resulting in mummification of the bodies. Based on the family chronicle and oral history, identities have been ascribed to the mummies. The aim of the study is therefore to test the accuracy of the historical records in comparison to archaeological, anthropological and genetic data. Today, the crypt houses eleven wooden coffins from the 17^th to 19^th century AD. In ten of these, mummified and scattered human remains were found. Archive records were studied in order to identify names, ancestry, titles, occupation, date of birth and death, and place of interment of the individuals. The coffins were visually inspected and dated by typo-chronology, and the mummified and scattered skeletal remains were subjected to a physical anthropological examination. In total, the crypt contains the remains of a minimum number of nine individuals, among them three adult males, five adult females and one infant. A detailed scientific examination, including prior conservation, ancient DNA analyses, and computed tomography (CT), was performed on five mummies. By means of the CT data age at death, sex, body height, pathologies, and anatomical variants were investigated. CT analysis further showed that the bodies were naturally mummified. Mitochondrial DNA analyses revealed that the tested individuals are not maternally related. In addition, health, living conditions and circumstances of death of the entombed individuals could be highlighted. Being confronted with the strengths, weaknesses and limitations of each methodological approach, probable identification was achieved in two cases.

Evidence of neurofibromatosis type 1 in a multi-morbid Inca child mummy: A paleoradiological investigation using computed tomography

Objective

In this study, an Inca bundle was examined using computed tomography (CT). The primary aim was to determine the preservation status of bony and soft tissues, the sex, the age at the time of death, possible indicators for disease or even the cause of death, as well as the kind of mummification. A secondary aim was to obtain a brief overview of the wrapping in order to gain additional information on the cultural background.

Materials and methods

The bundle belongs to the Museum of Cultures in Basel, Switzerland, and was bought in Munich, Germany, in 1921. Radiocarbon dating of the superficial textile yielded a calibrated age between 1480 and 1650 AD. The mummy was investigated using multi-slice CT with slice thickness of 0.75 mm and 110 kilovolt. For standardized assessment of soft tissue preservation, a recently developed checklist was applied.

Results

CT revealed the mummy of a seven to nine year old boy with superior preservation of bony and soft tissues allowing detailed assessment. Indicators of neurofibromatosis type 1 (paravertebral and cutaneous neurofibromas, a breast neurofibroma, sphenoid wing dysplasia), Chagas disease (dilatation of the esophagus, stomach, rectum, and large amounts of feces), and lung infection (pleural adherence, calcifications), probably due to tuberculosis, were found. Furthermore, signs of peri-mortem violence (transection of the chest and a defect in the abdominal wall) were detected. CT images revealed a carefully performed wrapping.

Conclusion

CT examination of the Inca bundle proved to be an important non-destructive examination method. Standardized assessment, especially of the soft tissue structures, allowed for diagnoses of several diseases, indicating a multi-morbid child at the time of death. The careful wrapping pointed to a ceremonial burial. Within the cultural background, the signs of fatal violence were discussed as a possible result of war, murder, accident, or human sacrifice.

From first to latest imaging technology: Revisiting the first mummy investigated with X-ray in 1896 by using dual-source computed tomography

Purpose

The aim of this study was to systematically reinvestigate the first human mummy that was ever analyzed with X-ray imaging in 1896, using dual-source computed tomography (DSCT) in order to compare the earliest and latest imaging technologies, to estimate preservation, age at death, sex, anatomical variants, paleopathological findings, mummification, embalming and wrapping of the child mummy from ancient Egypt. Radiocarbon dating was used to determine the mummy’s age and to specify the child’s living period in the Egyptian chronology.

Material and methods

The ancient Egyptian child mummy is kept in the Senckenberg Museum of Natural History in Frankfurt am Main, Germany. An accelerator mass spectrometer (MICADAS) was used for radiocarbon dating. DSCT was performed using a 2 × 64 slice dual-source CT system (Siemens Healthineers, Forchheim, Germany). A thorough visual examination of the mummy, a systematic radiological evaluation of the DICOM datasets, and established methods in physical anthropology were applied to assess the bio-anthropological data and the post mortem treatment of the body.

Results

Radiocarbon dating yielded a calibrated age between 378 and 235 cal BC (95.4% confidence interval), corresponding with the beginning of the Ptolemaic period. The mummy was a male who was four to five years old at the time of death. Remnants of the brain and inner organs were preserved by the embalmers, which is regularly observed in ancient Egyptian child mummies. Skin tissue, inner organs, tendons and/or musculature, cartilage, nerves and vasculature could be identified on the DSCT dataset. The dental health of the child was excellent. Anatomical variants and pathological defects included a congenital Pectus excavatum deformity, hepatomegaly, Harris lines, and longitudinal clefts in the ventral cortices of both femora.

Conclusion

Our results highlight the enormous progress achieved form earliest to latest imaging technology for advanced mummy research using the first human mummy investigated with X-ray. With the application of DSCT, detailed knowledge regarding age at death, sex, diseases, death, and mummification of a child from Ptolemaic Egypt are revealed while considering the temporary rites of body treatment and burial for children.

CT Scan of Thirteen Natural Mummies Dating Back to the XVI-XVIII Centuries: An Emerging Tool to Investigate Living Conditions and Diseases in History

Objectives

To correlate the radiologic findings detected with computed tomography scan with anthropological data in 13 naturally mummified bodies discovered during works of recovery of an ancient church in a crypt in Roccapelago, in the Italian Apennines.

Methods

From a group of about sixty not-intentionally mummified bodies, thirteen were selected to be investigated with volumetric computed tomography (CT). Once CT scan was performed, axial images were processed to gather MPR and Volume Rendering reconstructions. Elaborations of these images provided anthropometric measurements and a non-invasive analysis of the residual anatomical structures. For each body the grade of preservation and the eventual pathological changes were recorded. Furthermore, in order to identify nutritional and occupational markers, radiologic signs of bone tropism and degenerative changes were analysed and graded.

Results

Mummies included seven females and six males, with an estimated age ranging from 20 to 60 years. The first relevant finding identified was a general low grade of preservation, due to the lack of anatomic tissues different from bones, tendons and dehydrated skin. The low grade of preservation was related to the natural process of mummification. Analysing bone degenerative changes on CT scan, the majority of the bodies had significant occupational markers consisting of arthritis in the spine, lower limbs and shoulders even in young age. Few were the pathological findings identified. Among these, the most relevant included a severe bilateral congenital hip dysplasia and a wide osteolytic lesion involving left orbit and petrous bone that was likely the cause of death.

Conclusions

Although the low grade of preservation of these mummies, the multidisciplinary approach of anthropologists and radiologists allowed several important advances in knowledge for the epidemiology of Roccapelago. First of all, a profile of living conditions was delineated. It included occupational and nutritional conditions. Moreover, identification of some causes of death and, most importantly the definition of general living conditions.