title: Detection of ingested cocaine-filled packets--diagnostic value of unenhanced CT.
abstract: OBJECTIVE
  Emergency departments are facing nowadays an increasing number of illegal drug-related health problems, associated with medicolegal and/or social consequences. Body stuffers are street cocaine dealers, who either store wrapped packets of drugs in their rectum or hastily swallow them, prompted by fear of police's arrest. These packets can be life threatening in case of leakage. We evaluate the diagnostic value of unenhanced multidetector CT (MDCT) for detection of cocaine-filled packets (CFP) ingested by body stuffers in a phantom model.
  
  
  METHODS
  Our phantom simulated normal bowel contents in which a varying number of true and false CFP were randomly mixed. Both only differ in radiological density. During 18 different reading sessions, four radiologists independently evaluated the presence and number of true and false CFP. Interobserver agreement, sensitivity, specificity, positive and negative predictive value were calculated.
  
  
  RESULTS
  Interobserver agreement for detection of any packets, for visualization of true, and false CFP was good (kappa=0.63, 0.74 and 0.58, respectively). Sensitivity, specificity, positive and negative predictive value for detection of any packets was 95.6%, 100%, 100% and 62.5%, respectively; for visualization of the true CFP 86.5%, 100%, 100% and 77.6%, respectively; and for the false packets 98.1%, 65%, 88.6% and 87.5%, respectively.
  
  
  CONCLUSIONS
  Unenhanced MDCT without bowel preparation is a fast, reliable and easily reproducible imaging modality for the immediate detection of ingested CFP, thus facilitating medicolegal management of body stuffers.
authors.affiliation: Department of Radiology, University Hospital-CHUV, Rue du Bugnon, 1011 Lausanne, Switzerland. sabine.schmidt@chuv.ch
authors.forename: Sabine
authors.initials: S
authors.lastname: Schmidt
authors.forename: Olivier
authors.initials: O
authors.lastname: Hugli
authors.forename: Elena
authors.initials: E
authors.lastname: Rizzo
authors.forename: Domenico
authors.initials: D
authors.lastname: Lepori
authors.forename: F
authors.initials: F
authors.lastname: Gudinchet
authors.forename: Bertrand
authors.initials: B
authors.lastname: Yersin
authors.forename: Pierre
authors.initials: P
authors.lastname: Schnyder
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Meuwly
mesh_terms: D003042:Cocaine / Q000032:analysis*; D005547:Foreign Bodies / Q000000981:diagnostic imaging*; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging*; D019047:Phantoms, Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015813:Substance Abuse Detection / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003042:Cocaine