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Potential in MRI and PET-CT Lymphoma Cancer Characterization

By MedImaging International staff writers
Posted on 01 Apr 2013

Image: T1- and T2-weighted MR images of focal lesions before and after systemic treatment (Photo courtesy of Dr. Jens Hillengass, German Cancer Research Center in Heidelberg, Germany).

Image: Pre-treatment image of a patient with uptake in a mediastinal mass (Photo courtesy of Dr. Sally Barrington, London’s St. Thomas’ PET Imaging Center, UK).

Image: Complete metabolic response on interim PET scan (Photo courtesy of Dr. Sally Barrington, London’s St. Thomas’ PET Imaging Center, UK).

Images: Pre-treatment image of a patient with uptake in a mediastinal mass (Photo courtesy of Dr. Sally Barrington, London’s St. Thomas’ PET Imaging Center, UK).

Image: High-grade uptake on interim PET scan indicating chemoresistance (Photo courtesy of Dr. Sally Barrington, London’s St. Thomas’ PET Imaging Center, UK).

Utilizing magnetic resonance imaging (MRI) in disease evaluation and positron emission computed tomography-computed tomography (PET-CT) imaging in therapy response assessment could optimize patient outcome in lymphoma cancer.

“MRI gives us more information and is probably the most important imaging technique in assessing disease activity in myeloma,” said Dr. Jens Hillengass, a physician scientist from the German Cancer Research Center (Heidelberg, Germany) who presented his findings on March 9, 2013, during the State of the Art symposium at the European Congress of Radiology (ECR), held in Vienna (Austria).

Current guidelines for the evaluation of therapy response are chiefly based on serologic markers and reference imaging to track large soft-tissue tumors. However, Dr. Hillengass thinks that imaging, and in particular MRI and PET, should be included in the recommendations, at least in some patients. For instance, many myeloma patients show changes on MRI that are not visible on a skeletal survey. MRI helps to differentiate between bone and bone marrow; it also has higher sensitivity for imaging of bone marrow effects in total, and demonstrates the first infiltration of plasma cells before overstimulation of osteoclasts and the resulting bone destruction.

Recent research indicates that some patients show diffuse infiltration of bone marrow with malignant plasma cells while others show focal infiltration. Several studies have looked at the prognostic significance of findings from MRI and PET, and suggest that a higher number of focal lesions are associated with a worse prognosis, Dr. Hillengass explained. His research group found that if focal lesions in bone marrow disappear upon MRI, then the patient outcome is better than if remission is defined according to serological markers. Being able to show that lesions are still there could help indicate relapse, which is the case for most patients.

If additional indications suggest that MRI can be used to evaluate disease activity and the extent of bone marrow infiltration with plasma cells prior to bone destruction, there might be a stronger case for earlier treatment, before bone destruction has started, Dr. Hillengass believes. “There are good data to say that if lesions persist, then treatment should continue; these data are on high-risk disease based on cytogenetics, and suggest treating patients for a long time is beneficial,” he said.

Interim PET could be used to monitor response-adapted therapy in Hodgkin lymphoma and aggressive non-Hodgkin lymphoma, according to Dr. Sally Barrington, a consultant physician in nuclear medicine at London’s St. Thomas’ PET Imaging Center (UK), who also spoke during the symposium.

PET was added to new response criteria for lymphoma in 2007 for assessment of the end of treatment response. Adding PET to CT response criteria improved the accuracy of measurement of treatment response after chemotherapy, but earlier assessment of response is needed during the course of therapy to improve patient outcome, she explained. “After only one to two cycles of chemotherapy, interim PET can accurately predict response by monitoring the reduction in FDG [fluorodeoxyglucose] uptake, even before there is a change in tumor size,” said Dr. Barrington, who made her point by presenting the five-point scale (5-PS), also called the Deauville criteria, which has been used in trials to score response on early PET scans.

Related Links:
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62 (!!!!! 2341.0320281982): SELECT fid FROM jos_deeppockets WHERE id=294745460 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294745460 AND published='1' LIMIT 1

63 (!!!!! 3947.0195770264): 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 (114.91775512695): select jos_twitters.link from jos_twitters where cat=10

65 (41.007995605469): select jos_facebook.link from jos_facebook where cat=10

66 (41.961669921875): select jos_google_plus.link from jos_google_plus where cat=10

67 (39.100646972656): select jos_linkedin.link from jos_linkedin where cat=10

68 (61.988830566406): SELECT fid FROM jos_deeppockets WHERE id=294745460 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294745460 AND published='1' LIMIT 1

69 (42.915344238281): 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 (540.97175598145): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294745460 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (372.88665771484): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294745460 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 (!!!!! 5223.0358123779): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (108.00361633301): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (77.962875366211): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (52.213668823242): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 1410.961151123): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294745460 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (72.002410888672): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294745460 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (47.922134399414): 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 (134.94491577148): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1824.1405487061): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

105 (98.943710327148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

106 (93.221664428711): 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=294745460 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (649.92904663086): 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=294745460 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 6709.098815918): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

109 (121.8318939209): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

110 (!!!!! 3328.800201416): 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=294745460 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (816.10679626465): 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=294745460 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (787.01972961426): 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 (637.05444335938): 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 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

115 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

116 (85.830688476562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

117 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

118 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

119 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

120 (674.00932312012): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 82209.825515747): 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 (860.92948913574): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

123 (78.201293945312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

124 (859.97581481934): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294745460 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294745460 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 1947237.9684448): ( 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 (215.05355834961): ( 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 (92.029571533203): 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 (66.041946411133): 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 (670.9098815918): 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 (43.153762817383): 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 (37.908554077148): 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 (36.954879760742): 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 (616.78886413574): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (447.03483581543): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (190.01960754395): SELECT name FROM jos_deeppockets WHERE id=212

136 (66.041946411133): SELECT name FROM jos_deeppockets WHERE id=212

137 (657.79685974121): 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 (537.15705871582): 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 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

140 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

141 (!!!!! 28499.126434326): TRUNCATE TABLE jos_trademed_module

142 (!!!!! 1175.1651763916): 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=294745460 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (99.897384643555): 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=294745460 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (967.02575683594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

147 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

148 (!!!!! 1218.0805206299): 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 (133.03756713867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

150 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

151 (51.975250244141): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294745460 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294745460 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (472.06878662109): 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 (44.107437133789): 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 (35.04753112793): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (!!!!! 2959.0129852295): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

156 (139.95170593262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745460 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745460 AND published='1' LIMIT 1

157 (88.930130004883): select jos_twitters.link from jos_twitters where cat=10

158 (59.843063354492): select jos_facebook.link from jos_facebook where cat=10

159 (60.081481933594): select jos_google_plus.link from jos_google_plus where cat=10

160 (301.12266540527): select jos_linkedin.link from jos_linkedin where cat=10

161 (406.98051452637): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 5008.9359283447): insert into jos_banners_delta values (14615,'2025-06-20 06:27:49','216.73.216.120','view'),(14202,'2025-06-20 06:27:49','216.73.216.120','view'),(14203,'2025-06-20 06:27:49','216.73.216.120','view')

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