title: Comparison of abdominal computed tomography with and without oral contrast in diagnosis of body packers and body stuffers.
abstract: BACKGROUND
  Toxicity due to body packing/pushing/stuffing is a major concern in many countries. Of different imaging techniques, computed tomography (CT) scan is described as the method of choice in detecting body couriers, but there is no study to concomitantly compare with- and without-contrast abdominopelvic CTs to determine the more accurate one for this purpose.
  
  
  OBJECTIVE
  We aimed to evaluate the efficacy of abdominopelvic CT "with" and "without" oral contrast in diagnosis of existence, number, and type of packets in body packers/pushers and stuffers.
  
  
  METHODS
  In a prospective observational case series, all suspected cases of body packing/stuffing were included and underwent abdominopelvic CT with and without oral contrast in a one-year period. CT scans were reported by three independent attending radiologists blind to the demographic and clinical results and compared to our defined "gold standard" which was surgery or expulsion of packets. The existence and number of packets detected by each method were compared to define the better method of diagnosis.
  
  
  RESULTS
  Of 11 suspect body packers/pushers, 10 carried packs. Abdominopelvic CT with and without oral contrast detected six and seven of them, respectively. In 24 body stuffers, CT without oral contrast was more accurate in diagnosis of existence (9/24 vs. 7/24, p = 0.003) and number (sensitivity and positive predictive values of 29.2% vs. 37.5% and 100% vs. 100% for CTs with and without oral contrast, respectively, p = 0.021).
  
  
  CONCLUSIONS
  There is a remarkable gap between detection of existence and number of packets/baggies reported by the radiologists and the real condition of the patients. A close teamwork between radiologists and toxicologists is needed to manage these problematic cases.
authors.affiliation: Department of Radiology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Scineces , Tehran , Iran.
authors.forename: Makhtoom
authors.initials: M
authors.lastname: Shahnazi
authors.forename: Hossein
authors.initials: H
authors.lastname: Hassanian-Moghaddam
authors.forename: Latif
authors.initials: L
authors.lastname: Gachkar
authors.forename: Narjes
authors.initials: N
authors.lastname: Ahmadi
authors.forename: Nasim
authors.initials: N
authors.lastname: Zamani
authors.forename: Hooman
authors.initials: H
authors.lastname: Bahrami-Motlagh
authors.forename: Taraneh
authors.initials: T
authors.lastname: Faghihi Langroudi
authors.forename: Abbas
authors.initials: A
authors.lastname: Arjmand Shabestari
authors.forename: Afshin
authors.initials: A
authors.lastname: Mohammad Alizadeh
mesh_terms: D000005:Abdomen / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging*; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D013287:Illicit Drugs
keywords: Body packer; Body pusher; Body stuffer; CT scan with and without oral contrast; Drug trafficking; Poisoning