Porous skeletal lesions in perspective: The role of radiology and microscopy for paleopathological analysis

OBJECTIVE: Porous skeletal lesion (PSL) is a descriptive term for bone altered by macroscopic perforations or pits. This paper seeks to assist researchers in meaningfully interpreting PSLs by offering perspectives on the currently available imaging modalities and approaches to better evaluate these important lesions. As a macro-morphological category, PSL is diagnostically non-specific; such lesions can result from formative defects, resorptive activity, or their interplay, and may be seen in normal development, disease and related conditions. METHODS: We outline imaging modalities available for investigating PSL: macroscopic methods, microscopy (including histology), radiography (including computed tomography), and more recent clinical techniques such as magnetic resonance imaging. RESULTS: Each modality produced useful information about PSLs and had strengths and weaknesses. CONCLUSIONS: Although macroscopic observation is often the most widely available, it is frequently insufficient to differentiate proximate causes and ultimate diagnostic probabilities. For a detailed understanding of tissue-level pathophysiology, the high resolution and visibility of internal features provided by micro-CT and microscopy are strong diagnostic aids, while clinical modalities (CT, radiography, MRI) offer the advantage of enabling comparisons with PSLs in contemporary populations and links to soft tissue features. SIGNIFICANCE: The spectrum of techniques now available offers options to all researchers. Understanding the potential and limitations is, however, critical to getting the most from any investigation. SUGGESTIONS FOR FUTURE RESEARCH: We advocate for more cross-sectional imaging of PSLs to better understand the etiologies and morphological distinctions of these lesions. Greater integration of clinical techniques and data offers considerable potential for better understanding deceased individuals.