Detection of Ingested Cocaine-filled Packets: Diagnostic Value of Native Multidetector CT

PURPOSE: Emergency departments nowadays have to deal with an increasing number of health problems of high medicolegal and social importance, such as drug abuse. Cocaine dealers caught by the police by surprise often swallow wrapped packets of drugs in order to escape, which can be life-threatening in case of leakage. We evaluate the diagnostic value of native multideteCTor CT (MDCT) for the deteCTion of cocaine-filled packets ingested by body stuffers. METHOD AND MATERIALS: We performed a phantom study (16-row MDCT, slice thickeness/reconstruCTion 2.5mm/2mm, pitch 1.3)simulating normal bowel contents in which a varying number of true and false cocaine-filled packets were randomly mixed. Both only differ in their radiological density. During 18 different reading sessions four radiologists independently evaluated presence and number of true and false cocaine-filled packets. Sensitivity, specificity, positive (PPV) and negative (NPV) prediCTive value and interobserver agreement were calculated. RESULTS: Interobserver agreement for deteCTion of any packets and for visualization of true cocaine-filled packets was good (k = 0.63 respeCTively k = 0.74), it was moderate concerning the false packets (k = 0.58). Sensitivity, specificity, PPV and NPV for deteCTion of any packets was 96%, 100%, 100% respeCTively 63%, for visualization of true cocaine-filled packets 87%, 100%, 100% respeCTively 78%, and for the false packets 98%, 65%, 89% respeCTively 88%. CONCLUSION: Native MDCT without bowel preparation is a reliable and reproduCTive imaging modality for the immediate deteCTion of ingested cocaine-filled packets including their precise number. Clinical managament of the body stuffers then becomes much easier since leakage of one of these bags exposes the carrier to the toxic effeCTs of the drug. CLINICAL RELEVANCE/APPLICATION: Native MDCT thus not only essentially contributes to the clinical management of cocaine dealers, but also helps resolving legal questions by immediate and accurate count of the ingested drugs, if any