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

<div><p>The purpose of this study was to develop a checklist for standardized assessment of soft tissue preservation in human mummies based on whole-body computed tomography examinations, and to add a scoring system to facilitate quantitative comparison of mummies. Computed tomography examinations of 23 mummies from the Capuchin Catacombs of Palermo, Sicily (17 adults, 6 children; 17 anthropogenically and 6 naturally mummified) and 7 mummies from the crypt of the Dominican Church of the Holy Spirit of Vilnius, Lithuania (5 adults, 2 children; all naturally mummified) were used to develop the checklist following previously published guidelines. The scoring system was developed by assigning equal scores for checkpoints with equivalent quality. The checklist was evaluated by intra- and inter-observer reliability. The finalized checklist was applied to compare the groups of anthropogenically and naturally mummified bodies. The finalized checklist contains 97 checkpoints and was divided into two main categories, “A. Soft Tissues of Head and Musculoskeletal System” and “B. Organs and Organ Systems”, each including various subcategories. The complete checklist had an intra-observer reliability of 98% and an inter-observer reliability of 93%. Statistical comparison revealed significantly higher values in anthropogenically compared to naturally mummified bodies for the total score and for three subcategories. In conclusion, the developed checklist allows for a standardized assessment and documentation of soft tissue preservation in whole-body computed tomography examinations of human mummies. The scoring system facilitates a quantitative comparison of the soft tissue preservation status between single mummies or mummy collections.</p></div

Differences between the scores of anthropogenically and naturally mummified bodies.

<p>Differences are given as a mean (95% confidence interval); n.s.: not significant p>0.05.</p

Subcategory Central Nervous System and Peripheral Nerves.

<p>Axial (<b>a, b, d-g</b>) and sagittal (<b>c</b>) multiplanar reconstructions. <b>a</b> (P3) Preservation of the brain as a <i>mass</i> forming a kind of dried fluid-level at the deepest point of the skull with additional <i>fragments</i> of parenchyma. <b>b, c</b> (P20) Improved preservation status with identifiable <i>cerebrum</i>, <i>cerebellum</i> and <i>brainstem</i>. Note soft tissues of the <i>nose</i>, the <i>falx</i> and the <i>tentorium</i>, and the <i>tongue</i> in <b>(c)</b>. <b>d</b> (P1) The <i>trigeminal nerve</i> (arrows) can be found bilaterally in its anatomical course. Note <i>bulb and/or lens</i>, <i>tentorium</i>, <i>falx</i>, <i>tendons and/or musculature skull-base</i>, parts of the <i>cerebellum</i>, and <i>brainstem</i>. <b>e</b> (P1) The <i>facial nerve</i> is detectable on the right side (arrow) and suggested on the left side. Note bilateral <i>auricles</i>, <i>bulb and/or lens</i>, <i>ossicles</i>, <i>tendons and/or musculature skull-base</i> and <i>cerebellum</i>. <b>f</b> (P3) The <i>cervical spinal cord</i> and <i>dura</i> are shown as one single structure. The <i>peripheral cervical nerves</i> are visible inside the neuroforamina. Note <i>tendons and/or musculature neck</i>, and the thyroid cartilage as part of the <i>hypophyarynx and/or larynx</i>. <b>g</b> (P1) The <i>thoracic spinal cord</i> and <i>dura</i> are discernible and the <i>peripheral thoracic nerves</i> are detectable inside the neuroforamina. Note <i>tendons and/or musculature thoracic and lumbar spine</i>.</p

Subcategory Genitourinary System.

<p>Axial (<b>a-d, f, g</b>) and sagittal (<b>e</b>) multiplanar reconstructions. <b>a</b> (P21) Both <i>kidneys</i> are shown as clearly shrunken hyperdense organs with discernible parenchyma and renal pelvis. Note <i>peripheral nerves lumbar</i> bilaterally inside the neuroforamina. <b>b</b> (V3) A different kind of preservation of both <i>kidneys</i> in the form of hypodense parenchyma and hyperdense margin. Note <i>tendons and/or musculature right forearm</i>, <i>intestine</i>. <b>c</b> (V3) The distended <i>urinary bladder</i> (asterisk) is visible with a dried fluid level dorsally. Note <i>capsule and/or labrum</i> of both <i>hips</i>, <i>rectum and/or anus</i> with dried fluid level. <b>d</b> (P21) The <i>prostate</i> is detectable as a shrunken structure surrounding the urethra (arrow). Note <i>rectum and/or anus</i>. <b>e</b> (V9) Visible <i>uterus</i> with cavum (arrow) and hyperdense margin. Note <i>intervertebral discs lumbar spine</i>, <i>intestine</i>. <b>f</b> (P11) Penis and scrotum are shown. Note <i>tendons and/or musculature hand</i>, <i>tendons and/or musculature pelvis</i>. <b>g</b> (V17) <i>Labia</i> are clearly visible in this child mummy. Note <i>tendons and/or musculature thighs</i>.</p

Subcategory Cardiorespiratory System.

<p>Axial (<b>a-c</b>) and coronal (<b>d</b>) multiplanar reconstructions. <b>a</b> (P11) The <i>thyroid gland</i> is visible as a hyperdense organ surrounding the <i>trachea</i>. Note <i>spinal cord and/or dura thoracic</i>, <i>tendons and/or musculature thoracic and lumbar spine</i>. <b>b</b> (V14) Bilaterally, the <i>lung</i> is preserved in the form of completely collapsed lobes. Note <i>trachea</i>, <i>spinal cord and/or dura thoracic</i>, <i>tendons and/or musculature upper arms</i>. <b>c</b> (P11) Four chamber view of the heart demonstrating <i>pericardium</i>, <i>intraventricular septum</i>, <i>four chambers</i> with filling, <i>myocardium</i> and <i>valves</i> in a mummy with superior preservation status. Note also excellent preservation of both <i>lungs</i>, as well as the <i>esophagus</i> and <i>mediastinal/thoracic arteries</i>. <b>d</b> (P13) Different preservation status of the heart revealing only the <i>pericardium</i> (short arrows). The <i>diaphragm</i> (long arrows) supports a confident identification of the pericardial sack.</p

Subcategory Gastrointestinal System.

<p>Axial (<b>a-c</b>) and coronar (<b>d</b>) multiplanar reconstructions. <b>a</b> (P21) The distal <i>esophagus</i> (short arrow), the passage to the <i>stomach</i> and the upper part of the <i>stomach</i> (long arrow) are shown. Note proximal <i>abdominal aorta</i> with filling, <i>diaphragm</i>, <i>tendons and/or musculature thoracic and lumbar spine</i>. <b>b</b> (P21) The <i>intestine</i> is visible in the form of several horizontal layers. In the left abdomen an intestinal loop is clearly detectable (arrow). Note fibrous anulus inside the <i>lumbar intervertebral disc</i> space, <i>tendons and/or musculature thoracic and lumbar spine</i>. <b>c</b> (P11) The shrunken <i>liver</i>, <i>spleen</i> and <i>pancreas</i> are distinguishable. Note strong <i>diaphragm</i>. <b>d</b> (P21) The <i>gallbladder</i> with hyperdense filling and calcifications of the wall is shown in its typical anatomical position (arrow). Note the <i>liver</i>.</p

Subcategory Head.

<p>Paraaxial multiplanar reconstruction (P11) demonstrates the eye <i>bulb</i> bilaterally as an almost semicircular structure. The <i>lens</i> is detectable as a small hyperdense structure. The <i>optic nerve</i> is visible centrally between the <i>eye muscles</i>. The <i>auricles</i> are preserved bilaterally. Note <i>tendons and/or musculature skull-base</i> bilaterally in the form of the masseter muscle, as well as the <i>brainstem</i> and parts of the <i>cerebellum</i>.</p

Subcategory Vasculature-Arteries.

<p>Axial multiplanar reconstructions (<b>a-g</b>) <b>a</b> (P21) <i>Intracranial arteries</i> are detectable in the form of the intracranial segments of both internal carotid arteries (arrows). Note <i>bulb and/or lens</i>, <i>optic nerve</i>, <i>eye muscles</i>, <i>auricles</i>, <i>cerebellum</i>. <b>b</b> (P1) <i>The cervical carotid arteries</i> (short arrows) are bilaterally shown in terms of the common carotid artery. Note <i>trachea</i> and <i>esophagus</i> dorsally adjacent to the trachea. <b>c</b> (P1) From the <i>coronary arteries</i> the left descending artery (arrow) is detectable. Note collapsed <i>lung</i> on the right side and well preserved <i>lung</i> on the left side, as well as <i>spinal cord and/or dura thoracic</i>, <i>mediastinal/thoracic arteries</i>. <b>d</b> (P1) The <i>abdominal aorta</i> is visible as a flattened structure prevertebrally (arrow). Note <i>lung</i>, <i>liver</i>, <i>spleen</i>, <i>tendons and/or musculature left upper arm</i>. <b>e</b> (P21) The <i>pelvic arteries</i> are shown bilaterally in terms of the external iliac arteries (arrows). Note <i>peripheral nerves sacral</i>. <b>f</b> (P1) The <i>thigh arteries</i> are bilaterally visible in terms of the superficial femoral arteries (arrows). Note <i>tendons and/or musculature thigh</i>. <b>g</b> (P1) The <i>lower leg arteries</i> are visible on the right side (arrows). Note <i>tendons and/or musculature lower leg</i>. </p

The checklist for assessment and documentation of soft tissue structures in CT examinations of human mummies and the scoring system.

<p>The checklist for assessment and documentation of soft tissue structures in CT examinations of human mummies and the scoring system.</p

Subcategory Musculoskeletal System.

<p>Axial (<b>a, b</b>), coronal (<b>c</b>) and sagittal (<b>d</b>) multiplanar reconstructions. <b>a</b> (P1) On the left shoulder the <i>rotator cuff</i>, the <i>long biceps tendon</i> inside the intertubercular sulcus, as well as the <i>capsule</i> and <i>labrum</i> are detectable. <b>b</b> (P1) Both hips reveal the <i>capsule</i> and <i>labrum</i>. Note <i>tendons and/or musculature pelvis</i>. <b>c</b> (P1) On the right knee the <i>posterior cruciate ligament</i> and the <i>medial</i> and <i>lateral meniscus</i> are visible. Note <i>tendonds and/or musculature thigh</i> and <i>lower leg</i>. <b>d</b> (P11) The thoracic and lumbar spine reveals <i>intervertebral discs</i> in the form of remnants of the fibrous anulus.</p