Thesis title: Differential diagnosis of cribra orbitalia at Christ Church Spitalfields via micro-CT analysis.
The primary objective of my research is to use a non-destructive imaging technique, x-ray micro-computed tomography (micro-CT), to elucidate the aetiology and localised distribution of a frequently occurring pathology in human skeletal remains: cribra orbitalia. In the palaeopathological literature, these lesions have become synonymous with a diagnosis of iron-deficiency anaemia, and macroscopic interpretations from them have been used to evaluate the implications of transitions in subsistence strategies and social complexity on human health. Recent research has demonstrated, however, that scurvy, rickets and infection can also create porous areas of bone that cannot be macroscopically differentiated from those caused by anaemia. While differential diagnosis of cribra orbitalia can be achieved using histological analysis, this method of study is destructive, making it unsuitable for routine use. Using micro-CT, a high-resolution, non-destructive imaging technique, and the volume rendering software Drishti, my research seeks to address several discrepancies that presently confound macroscopic diagnosis of cribra orbitalia and porotic hyperostosis, thereby permitting more accurate diagnosis of these cranial lesions. In particular, I will examine whether lesions localized to a specific sector of the orbital roof are correlated with aetiology, since this could have implications for macroscopic diagnoses. Also, varying lesion presentations have been used to identify mild through severe forms of iron-deficiency anaemia, though it is now unclear whether these diagnoses are accurate. Therefore, I will also investigate the relationship between the "type" of lesion (porotic, cribrotic or trabecular) and its aetiology. In particular, whether the more severe forms of cribra orbitalia always represent marrow hypertrophy, or anaemia.