“Drug mules” as a radiological challenge

Abstract

Purpose The purpose of this pictorial essay was to retrospectively evaluate the specificity, sensitivity and accuracy of computed tomography (CT), digital radiography (DR) and low-dose linear slit digital radiography (LSDR, Lodox) whlist emphasizing on radiological signs and pitfalls in the detection of internal cocaine containers. Methods Institutional review board approval was obtained. The presented study collective consisted of 83 patients (76 male, 7 female, 16–45 years) suspected of having incorporated cocaine drug containers. All underwent radiological imaging, a total of 135 exams were performed: n CT=35, n DR=70, n LSDR=30. An overall calculation of all “drug mules” and a specific evaluation of body packers, pushers and stuffers were performed. The gold standard was stool examination in a dedicated holding cell equipped with a drug toilet. Results There were 54 drug mules identified in this study. CT of all drug carriers showed the highest diagnostic accuracy 97.1%, sensitivity 100% and specificity 94.1%. DR in all cases was 71.4% accurate, 58,3% sensitive and 85,3% specific. LSDR of all patients with internal cocaine was 60% accurate, 57.9% sensitive and 63.4% specific. Conclusion CT was the most accurate test studied. Therefore, the detection of internal cocaine drug packs should be performed by CT, rather than by conventional x-ray, in order to apply the most sensitive exam in the medico-legal investigation of suspected drug carriers. Nevertheless, the higher radiation applied by CT than by DR or LSDR needs to be considered. Future studies should include evaluation of low dose CT protocols in order to address germane issues and to reduce dosage.