Keywords:
Forensic / Necropsy studies, Abdomen, CT, Experimental, Diagnostic procedure, Foreign bodies, Forensics, Drugs / Reactions
Authors:
M. Scherr, J. Grimm, S. Wirth, E. Ziegeler, M. Uhl, M. F. Reiser; Munich/DE
DOI:
10.1594/ecr2011/C-1523
Purpose
To evaluate in vitro and in a porcine model the differentiability between different substances in packages containing illicit drugs via Spectral Imaging CT (SICT) of a body packer.
(Study BOPACT III)
Background:
Due to increasing lagguage security at airports and postage control at customs there is an increase in body packers swallowing packages of illicit drugs or insert them into the rectum/vagina for transportation and smuggling.
Radiologists are confronted with body packers in two typical scenarios:
- As patients,
who may present with severe and live threatening symptoms as a result of packet rupture
- More frequently,
authorities present suspects apprehended under suspicion of body packing
The radiologist’s task:
- Differentiate body packs from physiological structures based on content,
shape,
and e.g.
typical wrapping with radiologic procedures like CT,
X-ray or ultrasound
- Count drug packages
- Not yet possible but appreciated: prediction of body pack content to estimate the risk in case of package rupture (drug concentration,
heroin vs.
cocain) and possibility of drug antagonisation (heroin).
It is known that CT is the most sensitive modality for body pack detection with a sensitivity of up to 100 % (1).
Yet,
plain film radiology remains the clinical standard due to reduced radiation risk,
resources and time consumption (1),
even though sensitivities range from only 47 to 95 % (2).
Former studies propose typical levels of CT attenuation (HU levels) for different drugs (3).
Our own experience with body packs in CT yield an significant overlap of HU levels especially between packages containing heroin and cocaine compounds at standard abdominal CT.
Studies on dual energy discrimination of different urinary calculi (4) or gallstones (5) showed promising results in differentiation of "non physiological incorporated" material.
Aim of our study was to use the next step of dual energy scanner (SICT) providing absorption curves to differentiate illicit drugs in vitro and in a porcine model.