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AAPM 2025 - 67th Annual Meeting & Exhibition of the American Association of Physicists in Medicine

fMRI Identifies Asymptomatic Individuals at Risk for Stroke

By MedImaging International staff writers
Posted on 02 Oct 2014

Image: Simplified illustration shows disease simulation model. Patients start in the 70%– 89% luminal narrowing state and progress or regress to other narrowing states, experience a stroke, undergo revascularization (revasc), or die of stroke-related or nonstroke-related causes (Photo courtesy of the Radiological Society of North America).

Image: Tornado Diagram for CVR Strategy. Diagram summarizes one-way sensitivity analyses for the CVR strategy compared with the medical therapy strategy for the base-case analysis. Most ICERs were close to the base-case result (USD 20,000 per QALY) because model parameters were varied through plausible ranges, with the exceptions of the cost of revascularization and the cost of chronic stroke care. Parameters are shown in descending order of influence on model results. RR = risk ratio (Photo courtesy of the Radiological Society of North America).

Imaging can be a cost-effective way to identify people at risk for stroke who might benefit from aggressive intervention, according to a new modeling study.

The findings were published online September 2014 in the journal Radiology. The study examined people with asymptomatic carotid artery stenosis, a narrowing of the major blood vessels supplying blood to the head due to atherosclerosis (plaque accumulation). Carotid artery stenosis is the primary cause of up to 20% of ischemic strokes, which result from an obstruction within a blood vessel and make up 85% of all strokes.

Stroke victims frequently undergo revascularization procedures such as carotid endarterectomy (surgical removal of the plaque) to restore blood flow, but use of the procedures in asymptomatic patients is more controversial, according to Ankur Pandya, PhD, assistant professor of healthcare policy and research and public health in radiology at Weill Cornell Medical College (New York, NY, USA). “There are complications and costs associated with these revascularization procedures, and they are often done without knowing if the risks and costs are worth the benefits,” Dr. Pandya said.

Dr. Pandya and colleagues recently evaluated the impact of cerebrovascular reserve (CVR) testing, a measure of blood flow reserve to the brain, on asymptomatic people with significant carotid artery stenosis. While different imaging modalities can be used in CVR testing, the researchers used transcranial Doppler (TCD) sonography, an inexpensive, widely available option that does not expose patients to ionizing radiation. They constructed a mathematical model that allowed them to make hypothetical comparisons among three diverse approaches: CVR testing, immediate revascularization with carotid endarterectomy, and medical therapy-based management with subsequent revascularization only for patients whose stenosis got worse.

The CVR-based strategy, which led to approximately 50% of the patients receiving revascularization, appeared to have the most favorable balance of benefits and costs. The medical therapy-based approach was associated with the lowest lifetime costs and the fewest revascularizations; however, it also resulted in the lowest life expectancy and lifetime quality-adjusted years, which account for both the quality and length of life experienced by patients. The immediate revascularization strategy had the highest costs, by a wide margin, and only incremental health benefits compared with the CVR-based approach.

“The study results show that imaging can be a cost-effective tool to stratify patients by risk of stroke and help sort patients into invasive, expensive interventions and less invasive options,” Dr. Pandya said.

Dr. Pandya reported that CVR testing also has the potential to help characterize whether carotid artery plaque is causing abnormal brain blood flow patterns which may, therefore, identify the patients who are at greatest risk of stroke. “CVR testing with ultrasound could be used to stratify patients by risk based on abnormal blood flow patterns to the brain, and then other imaging tests like MRI could be employed to look at the composition and stability of plaque, which may give greater insight into those plaques most likely to rupture and cause symptoms,” Dr. Pandya said.

Cost-effectiveness models such as the one used in the study have gained acceptance recently and are already used by healthcare payers in Canada, Europe, and Australia. Dr. Pandya expects these models to become more prominent in the United States as healthcare reform evolves. “Our model takes all these pieces of information on risks, costs and benefits and does the math in a systematic way to help clinicians make decisions,” he said.

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57 (!!!!! 1266.9563293457): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

58 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

59 (109.19570922852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

60 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

61 (117.06352233887): 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 (508.06999206543): SELECT fid FROM jos_deeppockets WHERE id=294754938 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754938 AND published='1' LIMIT 1

63 (341.17698669434): 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 (52.928924560547): select jos_twitters.link from jos_twitters where cat=10

65 (28.848648071289): select jos_facebook.link from jos_facebook where cat=10

66 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

67 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

68 (36.001205444336): SELECT fid FROM jos_deeppockets WHERE id=294754938 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754938 AND published='1' LIMIT 1

69 (31.948089599609): 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 (282.04917907715): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (293.97010803223): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (59.127807617188): 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 (73.909759521484): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (87.02278137207): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (83.92333984375): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (51.975250244141): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (36.954879760742): 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 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

105 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

106 (52.928924560547): 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=294754938 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=294754938 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (646.11434936523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

109 (157.83309936523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

110 (71.048736572266): 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=294754938 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (492.09594726562): 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=294754938 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (595.0927734375): 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 (340.93856811523): 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 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

115 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

116 (47.206878662109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

117 (36.001205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

118 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

119 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

120 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

121 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

122 (310.89782714844): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 55531.978607178): 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 (483.03604125977): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754938 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754938 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (51.975250244141): ( 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 (38.862228393555): ( 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 (34.093856811523): 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 (29.802322387695): 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 (35.04753112793): 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 (30.040740966797): 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 (29.087066650391): 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 (30.994415283203): 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 (27.894973754883): 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 (27.894973754883): 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 (488.0428314209): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (362.87307739258): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (171.89979553223): SELECT name FROM jos_deeppockets WHERE id=212

138 (116.82510375977): SELECT name FROM jos_deeppockets WHERE id=212

139 (740.05126953125): 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 (755.07164001465): 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 (141.14379882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

142 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

143 (!!!!! 10531.902313232): TRUNCATE TABLE jos_trademed_module

144 (133.03756713867): 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=294754938 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (85.830688476562): 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=294754938 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (451.08795166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (190.97328186035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

149 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

150 (!!!!! 1635.0746154785): 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 (96.797943115234): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

152 (60.796737670898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

153 (53.167343139648): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754938 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754938 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (59.127807617188): 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 (40.769577026367): 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 (44.107437133789): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (186.92016601562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

158 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754938 AND published='1' LIMIT 1

159 (61.03515625): select jos_twitters.link from jos_twitters where cat=10

160 (35.04753112793): select jos_facebook.link from jos_facebook where cat=10

161 (37.908554077148): select jos_google_plus.link from jos_google_plus where cat=10

162 (36.954879760742): select jos_linkedin.link from jos_linkedin where cat=10

163 (401.02005004883): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (981.09245300293): insert into jos_banners_delta values (14615,'2025-06-23 18:40:31','216.73.216.120','view'),(14202,'2025-06-23 18:40:31','216.73.216.120','view'),(14203,'2025-06-23 18:40:31','216.73.216.120','view')

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