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Combining MRI and PET with CSF Analysis Provides a Better Prediction of Alzheimer’s Disease

By MedImaging International staff writers
Posted on 19 Dec 2012

Being able to predict Alzheimer’s diseases (AD) in patients with mild cognitive impairment can be enhanced by using a combination of imaging and biomarker technology.

The study’s findings, which were published December 11, 2012, in the journal Radiology, provide new clues into how to best detect AD before the full onset of the disease. Investigators from Duke University (Durham, NC, USA) assessed three tests--cerebrospinal fluid analysis, fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET), and magnetic resonance imaging (MRI)--to determine whether the combination provided more accuracy than each test individually. The tests were added to routine clinical exams, including neuropsychologic testing, currently used to diagnose AD.

“This study marks the first time these diagnostic tests have been used together to help predict the progression of Alzheimer’s. If you use all three biomarkers, you get a benefit above that of the pencil-and-paper neuropsychological tests used by doctors today,” said Jeffrey Petrella, MD, an associate professor of radiology at Duke Medicine and study author. “Each of these tests adds new information by looking at Alzheimer’s from a different angle.”

AD affects more than 30 million people worldwide, and the number is expected to triple by 2050. Patients with mild cognitive impairment are at a higher risk for having Alzheimer’s, but not everyone will progress to developing the disease. Studies suggest that AD begins years to decades before it is diagnosed, with patients experiencing a phase with some memory loss, or mild cognitive impairment, before the disorder’s full onset.

Whereas there is no cure for Alzheimer’s, new treatments are being researched are likely to be most effective at the disease’s earliest stages. Researchers are working to improve early detection of AD, even before patients experience symptoms, but the disease remains difficult to diagnose and patients are often misclassified.

“Misdiagnosis in very early stages of Alzheimer’s is a significant problem, as there are more than 100 conditions that can mimic the disease. In people with mild memory complaints, our accuracy is barely better than chance. Given that the definitive gold standard for diagnosing Alzheimer’s is autopsy, we need a better way to look into the brain,” said P. Murali Doraiswamy, MBBS, professor of psychiatry and medicine at Duke and study author. “Physicians vary widely in what tests they perform for diagnosis and prognosis of mild memory problems, which in turn affects decisions about work, family, treatment, and future planning.”

The Duke investigators analyzed data from 97 older adults with mild cognitive impairment from the Alzheimer’s Disease Neuroimaging Initiative, a national study that collects data in hundreds of elderly patients with varying degrees of cognitive impairment. Participants took part in clinical cognitive testing, as well as the three diagnostic tests: MRI, FDG-PET, and cerebrospinal fluid (CSF) analysis. They then checked in with their physicians for up to four years.

The misclassification rate based only on neuropsychologic testing and other clinical data was comparatively high at 41.3%. Adding each of the diagnostic tests reduced the number of misdiagnoses so that, with all three tests combined, researchers achieved the lowest misclassification rate of 28.4%. FDG-PET, out of the three individual diagnostic tests, contributed the most information to clinical testing to identify early Alzheimer’s in patients with mild cognitive impairment.

Researchers noted that while the tests clearly provided the most diagnostic information when used in combination, additional studies are needed to better determine their role in a clinical environment. “The study used a unique data-mining algorithm to analyze MRI and PET images for ‘silent’ information that may not be apparent to the naked eye. Hence, the data should not be taken to mean that imaging should be done in every patient; rather, it sought to capture the maximum potential information available in the images,” Dr. Petrella said. “Additional studies, including those looking at the cost effectiveness of these tests, are also needed to translate the most useful biomarkers into clinical practice.”

A multicenter study led earlier in 2012 by Dr. Doraiswamy demonstrated that another type of PET scan that tags amyloid plaques in the brains of individuals with AD also helped predict the onset of the disease in those with mild cognitive impairment. Adding amyloid plaque imaging technology in additional research could complement the modalities used in this research, providing even more diagnostic data.

Related Links:
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61 (124.93133544922): 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 (508.78524780273): SELECT fid FROM jos_deeppockets WHERE id=294743888 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743888 AND published='1' LIMIT 1

63 (65.088272094727): 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 (62.942504882812): select jos_twitters.link from jos_twitters where cat=10

65 (33.140182495117): select jos_facebook.link from jos_facebook where cat=10

66 (43.869018554688): select jos_google_plus.link from jos_google_plus where cat=10

67 (46.968460083008): select jos_linkedin.link from jos_linkedin where cat=10

68 (36.001205444336): SELECT fid FROM jos_deeppockets WHERE id=294743888 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743888 AND published='1' LIMIT 1

69 (36.001205444336): 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 (409.12628173828): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743888 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (383.13865661621): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743888 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (56.028366088867): 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 (65.803527832031): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (44.822692871094): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (86.069107055664): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743888 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (36.954879760742): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743888 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (37.908554077148): 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 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (83.208084106445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

105 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

106 (75.817108154297): 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=294743888 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (73.19450378418): 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=294743888 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (113.96408081055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

109 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

110 (81.062316894531): 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=294743888 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (710.01052856445): 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=294743888 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (833.98818969727): 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 (585.07919311523): 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 (173.09188842773): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

115 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

116 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

117 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

118 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

119 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

120 (430.82237243652): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 52953.004837036): 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

122 (169.99244689941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

123 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

124 (710.96420288086): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743888 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743888 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 745146.98982239): ( 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 (98.943710327148): ( 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 (79.154968261719): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (50.067901611328): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (63.180923461914): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (44.822692871094): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (43.869018554688): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (!!!!! 1148.9391326904): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (994.92073059082): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (945.09124755859): SELECT name FROM jos_deeppockets WHERE id=212

136 (61.988830566406): SELECT name FROM jos_deeppockets WHERE id=212

137 (725.98457336426): 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

138 (663.04206848145): 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

139 (!!!!! 1031.1603546143): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

140 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

141 (!!!!! 19895.076751709): TRUNCATE TABLE jos_trademed_module

142 (!!!!! 1157.0453643799): 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=294743888 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (601.05323791504): 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=294743888 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (630.14030456543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (104.90417480469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

147 (75.817108154297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

148 (!!!!! 1794.0998077393): 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

149 (114.91775512695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

150 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

151 (61.03515625): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743888 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743888 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (43.869018554688): 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)

153 (41.961669921875): 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)

154 (54.121017456055): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

156 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743888 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743888 AND published='1' LIMIT 1

157 (234.12704467773): select jos_twitters.link from jos_twitters where cat=10

158 (123.97766113281): select jos_facebook.link from jos_facebook where cat=10

159 (!!!!! 3740.0722503662): select jos_google_plus.link from jos_google_plus where cat=10

160 (61.03515625): select jos_linkedin.link from jos_linkedin where cat=10

161 (977.99301147461): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1759.0522766113): insert into jos_banners_delta values (14615,'2025-06-20 11:28:02','216.73.216.120','view'),(14202,'2025-06-20 11:28:02','216.73.216.120','view'),(14203,'2025-06-20 11:28:02','216.73.216.120','view')

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