G. Fornaciari 1, V. Giuffra 1, M. Sabato 2, S. Minozzi 1, D. Caramella2, V. Ferrari 3, L. Ventura 4, G. Schenal 5, F. Mosca 6 3

  1. University of Pisa, Di vision of Paleopathology, History of Medicine and Bioethics, Department of Oncology, Tran plants and Advanced Technologies in Medicine, Pisa, Italy
  2. University of Pisa, Division of Di agnostic and Interventional Radiology, Department of Oncology, Transplants and Advanced Technologies in Medicine, Pisa, Italy
  3. University of Pisa, EndoCAS, Center for Computed Assisted Surgery, Pisa, Italy
  4. San Salvatore Hospital, Department of Pathology, L’Aquila, Italy
  5. AOUI Borgo Trento Hospital, Department of Radiology, Verona, Italy
  6. University of Pisa, Department of Oncology, Transplant s and Advanced Technologies in Medicine, Pisa, Italy

Keywords Paleopathology • Mummies • Computed tomography • Volume rendering

Computed Tomography (CT) has become a routinely non-invasive technique in paleopathology, allowing acquiring data about state of preservation, embalming techniques, presence of artefacts and diagnosis of diseases in ancient mummified bodies.
The mummies of Cangrande della Scala ( 129 1-1329) and S. Giacomo della Marca (ca. 139 1-1476) were exhumed and submitted to CT study. Cangrande della Scala is the most celebrated member of the Scaligeri dynasty, which ruled Verona from 1277 to 1387. Leading patron of the poet Dante Alighieri, Cangrande was a great warrior and important prince of his time. S. Giacomo della Marca was a Franciscan Friar, grand Inquisitor of Nap les, Bohemia and the Hungary kingdoms, who devoted his life to preaching.
Besides traditi on al CT acquisition, we decided to use 30 reconstruction and rendering techniques, a further evolution of radiological science applied to Paleopathology, in order to obtain information about the skeletal apparatu of these individuals. In particular, 30 reconstruction of the muscular insertions was aimed at the analysis of ergonomics and the evaluation of physical activity of these important personages of the Italian Middle Ages.

Total Body CT was performed on both mummies, using multi­detector spiral CT-equipment. The acquisition parameters were the following:

  • Cangrande della Scala: FOV (Field of View) 48 cm, Voltage 120, Amperage 50-360 mA, Slice Thickness 1mm;
  • San Giacomo della Marca : FOV (Field of View) 50 cm, Voltage 120, Amperage 50-360 mA, Slice Thickness 0.625mm;

Direct volume rendering and surface reconstruction after segmentation were used to evaluate the skeletal apparatus of the mummy ; two software were used to post-process CT Datasets: GE AW Volume Share 2, for multiparameter reconstructions and direct volume rendering, and open source software ITK SNAP 1 .5 for segmentation.

Volume rendering allowed good visualization of bone surfaces in correspondence of muscular insertions, except for areas involved in major joint s, as it was impossible to isolate the bone surfaces from the adjacent t ones, Figs. 1 and 2.
As for Cangrande della Scala, his reputation as a highly skilled horseman induced us to examine the skeletal markings left by habitual horseback riding (Jumbo-sacra! arthritis ; exostoses and ovalization of acetabula; hypertrophy of femoral rectum muscle; hypertrophy of the femoral biceps, great adductor, sma ll gluteu s, gluteal tuberosity, pectineus, lateral vastus and gastrocnemius; osteophytosis of femoral head and fovea and trocantheric fovea ; rotation and flattening of the small trochanter; hypertrophy of the soleus muscle). As a result, several of these features are present, confirming a strong physical activity linked to horseback practice.
With regard to Giacomo della Marca, attention was focused on his inferior limbs, as he was a Franciscan preacher used to covering large distances on foot, developing strong musculature of the pelvis and lower limbs. Our study evidenced well-developed muscular insertions, which confirmed the historical descriptions reporting on his strong walking activity.

The application of 30 rendering technique and segmentation routinely used in vivo to the study of human mummies can provide important information about skeletal apparatuses, with particular reference to ergonomics previously not evaluable in mummified bodies and only possible in skeletal remains through direct macroscopic study.