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Quantitative MR Angiography May Detect Narrowing in Intracranial Stents

By MedImaging International staff writers
Posted on 03 Mar 2009

Image: Colored MRA of a coronal view through the neck of a 38-year-old patient, showing a blocked right internal carotid artery, which has led to a bleed in the brain (Photo courtesy of Simon Fraser / Newcastle Hospitals NHS Trust).

Advances have been made in treating blockages in the arteries of the brain using angioplasty to widen the narrowed artery and a stent to keep the artery open. However, in-stent stenosis, or a re-blockage of the artery within the stent due to scar tissue or blood clots, is estimated to occur in up to 30% of patients and can cause a stroke or death. A new study has found that quantitative magnetic resonance angiography (QMRA) is a promising screening tool to identify in-stent stenosis with high sensitivity and specificity.

The study, performed by researchers, from Rush University Medical Center (Chicago, IL, USA), is available online and will appear in the March 2009 issue of a journal the American Heart Association Stroke.

Noninvasive imaging such as MRA and computerized tomography angiography (CTA) frequently cannot provide an accurate diagnosis of in-stent stenosis because the image is distorted by the reflection of metal stents or coils. Due to this problem, traditional angiography continues to be used routinely after stent placement to screen for in-stent stenosis. However, conventional angiography requires threading a catheter from the arteries in the groin to the brain and carries a slight risk of neurological and nonneurologic procedural complications.

QMRA is a flow analysis system that uses traditional MRI to produce a three-dimensional (3D) model of the vasculature and quantify vessel blood flow. The procedure is completely non-invasive and no contrast is needed. Recent studies have established this modality's use in the measurement of arterial blood flow in various cerebrovascular disorders and carotid bypass surgery; however, this is the first study to assess the use of QMRA in the detection of intracranial in-stent stenosis.

The study's investigators conducted a retrospective review of 14 patients who underwent stent placement for cerebral aneurysm or intracranial stenosis. All patients had a QMRA scan performed within one year after stent placement and a follow-up diagnostic angiography study performed within one month of the QMRA scan. An interventional neurologist reviewed all angiograms for presence of greater than 50% in-stent stenosis.

The study found that low blood flow as measured by QMRA at sites of intracranial stent placement was significantly associated with in-stent stenosis by catheter-based angiography. As a screening tool to predict greater than 50% in-stent stenosis, QMRA was 100% sensitive. In other words, QMRA was able to detect narrowing of stented arteries in all cases where invasive angiography showed greater than 50% stenosis.

"Given the potentially deadly consequences of in-stent stenosis, a test with high sensitivity and an acceptably low false-positive rate is desirable,” said Dr. Shyam Prabhakaran, section head of cerebrovascular disease and neurological critical care at Rush. "In addition, none of the patients with normal QMRA results had stenosis on angiography, suggesting that patients with normal QMRA results may not require follow-up catheter-based angiography.”

Due to the small sample size of the study, the investigators suggest larger prospective studies to confirm their findings.

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60 (986.09924316406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

61 (!!!!! 5192.9950714111): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (608.92105102539): SELECT fid FROM jos_deeppockets WHERE id=294722246 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722246 AND published='1' LIMIT 1

63 (612.02049255371): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (339.03121948242): select jos_twitters.link from jos_twitters where cat=10

65 (63.896179199219): select jos_facebook.link from jos_facebook where cat=10

66 (74.863433837891): select jos_google_plus.link from jos_google_plus where cat=10

67 (241.04118347168): select jos_linkedin.link from jos_linkedin where cat=10

68 (226.02081298828): SELECT fid FROM jos_deeppockets WHERE id=294722246 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722246 AND published='1' LIMIT 1

69 (58.174133300781): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (203.84788513184): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722246 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (310.89782714844): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722246 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (201.94053649902): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (26.226043701172): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (53.167343139648): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722246 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (29.087066650391): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722246 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (29.802322387695): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (52.213668823242): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (49.829483032227): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

105 (60.796737670898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

106 (48.87580871582): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722246 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (47.922134399414): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722246 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

109 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

110 (53.882598876953): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294722246 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (552.89268493652): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294722246 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (612.02049255371): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (363.11149597168): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (133.99124145508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

115 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

116 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

117 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

118 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

119 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

120 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

121 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

122 (386.95335388184): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 23077.011108398): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (707.86476135254): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722246 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722246 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 9325.9811401367): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (102.99682617188): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (358.10470581055): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (58.174133300781): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (220.06034851074): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (226.02081298828): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (138.99803161621): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (278.94973754883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (40.054321289062): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (444.88906860352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (514.03045654297): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (288.00964355469): SELECT name FROM jos_deeppockets WHERE id=212

138 (36.001205444336): SELECT name FROM jos_deeppockets WHERE id=212

139 (700.95062255859): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (588.17863464355): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

142 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

143 (!!!!! 10286.092758179): TRUNCATE TABLE jos_trademed_module

144 (130.89179992676): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722246 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (74.863433837891): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722246 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1070.9762573242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (80.82389831543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

149 (96.08268737793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

150 (!!!!! 1617.9084777832): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

152 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

153 (56.028366088867): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722246 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722246 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (82.015991210938): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

155 (43.153762817383): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

156 (52.213668823242): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (152.8263092041): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

158 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722246 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722246 AND published='1' LIMIT 1

159 (148.05793762207): select jos_twitters.link from jos_twitters where cat=10

160 (43.869018554688): select jos_facebook.link from jos_facebook where cat=10

161 (41.961669921875): select jos_google_plus.link from jos_google_plus where cat=10

162 (42.200088500977): select jos_linkedin.link from jos_linkedin where cat=10

163 (349.99847412109): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1283.1687927246): insert into jos_banners_delta values (14615,'2025-06-29 19:21:50','216.73.216.249','view'),(14202,'2025-06-29 19:21:50','216.73.216.249','view'),(14203,'2025-06-29 19:21:50','216.73.216.249','view')

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