Low dose dual-energy computed tomography in suspected body packers and body stuffers—Preliminary clinical experience

Abstract

Background The detectability of drug packages with abdominal plain film radiography is limited by sophisticated packaging methods and overlying stool, organs and bones. The aim of this study was to investigate the accuracy and practicability of dual-energy CT in body packers and stuffers, and the discernibility of cocaine from heroine. Materials and methods From May to December 2012 two suspected body packers and six suspected body stuffers (mean age of 30 years, range 20–43 years) were referred to our institution. A low dose native dual-energy CT of the abdomen and pelvis was performed in each case with tube currents of 14 mA s at 140 kV and 72 mA s at 80 kV. The data sets were reviewed for drug packages in a soft tissue and bone window as well as on color-encoded reformations of the dual energy index (DEI). Three-dimensional renderings of the DEI (cocaine material in green, heroine material in red) were produced to demonstrate findings to the police. Results In two body packers and three body stuffers an average of five drug packages were detected (range 1–11) with a mean size of 19 mm (range 9–39 mm). The mean attenuation of the packages was 151 HU (range 93–215 HU) at 80 kVp with an average decrease in attenuation of −92 HU (range −27 to −139 HU) at 140 kVp, suspicious of cocaine content in all cases. These results have been confirmed by chemical analysis of the defecated drug packages. The mean effective dose was 2.1 mSv (range 1.9–2.2 mSv), comparable to abdominal plain film radiographs with a typical effective dose of 1.3 mSv. Conclusion Dual-energy CT is a promising novel technique in detecting and characterizing drug packages in suspected body packers and stuffers. As most of these traffickers are of young age, the application of a low dose protocol is essential to limit the harm of ionizing irradiation.