MRI for body packers?

March 18, 2013, 5:16 pm

Body packer

★★½☆☆

Detection of body packing by magnetic resonance imaging: a new diagnostic tool? Bulakci M et al. Abdom Imaging 2012 Dec 9 [Epub ahead of print]

Abstract

What’s the best way to evaluate a suspected body packer? The authors of this paper note that CT scans are very sensitive, but involve high doses of radiation. (They do not mention low-dose CT, which at least one study suggests may be accurate and involve radiation exposure similar to that of a plain abdominal film.

In this Turkish study, the authors report on 16 suspected body packers who were brought to their hospital in Istanbul for evaluation and received a non-contrast MRI. (There is no indication if these were consecutive patients or how they were chosen.) MRI was interpreted as positive for drug packets. Ultimately, 13/14 of these were true positives. Apparently in the false-positive case intestinal gas was mistaken for drug packets;a non-contrast intestinal CT was negative. The authors conclude that:

. . . MRI appears to be an adequate and reliable method of diagnosing body packing as it contains no radiation and allows to rapidly obtain accurate images of the gastrointestinal tract.

This study is small and the authors admit that the results are only preliminary. Unfortunately, many important questions remain unanswered. How were the 3 other negative MRIs confirmed? How would the test performance compare with that of low-dose CT, which involves only a small amount of radiation exposure.) Did the study encounter any episodes of MRI-induced claustrophobia? Were all patients cooperative with the procedure?

In a letter responding to this article, Connors et al note that there are also ethical problems with the study, questioning whether truly informed consent could be obtained in patients brought to hospital by the police. The letter does have an amusing typo:

Considering the cost and lack of availability of MRI and the lack of comparison with plain radiographs or CT, or simply awaiting defection, broad implementation cannot be recommended at this time. [emphasis added]

I’m quite sure they meant “defecation”.

Related posts:

Low-dose abdominal CT is superior to plain film for imaging suspected body packers

Cannabis body packers

Treatment protocol for symptomatic body packers (mules) 

Cocaine mules: what to do with body packers

 

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