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MRI-Directed Contrast-Enhanced Mammography Improves Detection of Breast Lesions

By MedImaging International staff writers
Posted on 31 Aug 2022

$Image: MRI-directed CEM detects a higher fraction of suspicious MRI lesions (Photo courtesy of Unsplash)$

Image: MRI-directed CEM detects a higher fraction of suspicious MRI lesions (Photo courtesy of Unsplash)

Suspicious lesions detected on contrast-enhanced breast MRI often undergo targeted ultrasound evaluation to determine if they are amenable to ultrasound-guided biopsy. A new study aimed to assess the utility of MRI-directed contrast-enhanced mammography (CEM) performed for biopsy planning of suspicious MRI-detected breast lesions, with comparison to MRI-directed ultrasound. The study found that MRI-directed CEM detects a higher fraction of suspicious MRI lesions than MRI-directed ultrasound and also detects a higher fraction than either method individually.

The retrospective study by researchers at the University of Virginia Health System (Charlottesville, VA, USA) included 120 patients (median age, 50.3 years) who underwent MRI-directed CEM from September 2014 to July 2020 for biopsy planning of a total of 140 suspicious breast MRI lesions; 109 lesions were also evaluated by MRI-directed ultrasound at the same visit. Reference standard was histopathology or at least two years of imaging follow-up for benign lesions. Rates of detecting a correlate for the MRI lesion, among all lesions and among malignant lesions, were compared between MRI-directed CEM, MRI-directed ultrasound, and combined MRI-directed CEM and ultrasound (i.e., correlate detected on either modality) using McNemar's test. Frequencies of imaging modalities used for biopsy guidance after MRI-directed imaging were determined.

The study revealed that 21 of 109 lesions were malignant. The lesion detection rate was higher for MRI-directed CEM than for MRI-directed ultrasound [69.7% (76/109) vs 45.9% (50/109); p<.001], and higher for combined MRI-directed CEM and ultrasound [77.1% (84/109)] than for either MRI-directed CEM (p=.008) or MRI-directed ultrasound (p<.001). The malignant lesion detection rate was not significantly different between MRI-directed CEM and MRI-directed ultrasound [95.7% (22/23) vs. 78.3% (18/23); p=.13]. A total of 31.2% (34/109) of lesions were seen only on MRI-directed CEM, and 7.3% (8/109) were seen only on MRI-directed ultrasound. A total of 17.4% (4/23) of malignant lesions were seen only on MRI-directed CEM, and none were seen only on MRI-directed ultrasound. Among lesions recommended for biopsy, stereotactic- or tomosynthesis-guided biopsy was recommended for 25.2% (26/103), ultrasound-guided biopsy for 35.9% (37/103), and MRI-guided biopsy for 38.8% (40/103).

Based on these findings, the researchers concluded that MRI-directed CEM detects a higher fraction of suspicious MRI lesions than does MRI-directed ultrasound. MRI-directed CEM/ultrasound detects a higher fraction than either method individually. The researchers have suggested that MRI-directed CEM can be a useful alternate or complementary tool to MRI-directed ultrasound in biopsy planning for suspicious MRI lesions, facilitating use of biopsy guidance methods other than MRI guidance.

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60 (!!!!! 3690.0043487549): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

61 (127.07710266113): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

62 (!!!!! 12253.999710083): 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

63 (631.80923461914): SELECT fid FROM jos_deeppockets WHERE id=294794398 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294794398 AND published='1' LIMIT 1

64 (189.06593322754): 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`

65 (!!!!! 1189.9471282959): select jos_twitters.link from jos_twitters where cat=10

66 (37.193298339844): select jos_facebook.link from jos_facebook where cat=10

67 (138.99803161621): select jos_google_plus.link from jos_google_plus where cat=10

68 (32.186508178711): select jos_linkedin.link from jos_linkedin where cat=10

69 (170.94612121582): SELECT fid FROM jos_deeppockets WHERE id=294794398 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294794398 AND published='1' LIMIT 1

70 (!!!!! 1535.8924865723): 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`

71 (737.19024658203): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794398 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (550.98533630371): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794398 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (51.975250244141): 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`

74 (355.00526428223): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (441.07437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (!!!!! 5239.0098571777): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (107.0499420166): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (195.98007202148): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (!!!!! 3436.0885620117): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (593.90068054199): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (560.99891662598): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794398 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (40.054321289062): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794398 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (122.0703125): 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`

91 (!!!!! 4355.9074401855): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (140.90538024902): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (!!!!! 3451.1089324951): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (!!!!! 1778.1257629395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

106 (!!!!! 2542.9725646973): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

107 (105.85784912109): 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=294794398 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (606.06002807617): 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=294794398 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (!!!!! 7884.9792480469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

110 (!!!!! 4511.833190918): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

111 (276.08871459961): 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=294794398 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1184.9403381348): 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=294794398 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (911.95106506348): 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 (700.23536682129): 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

115 (355.00526428223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

116 (464.91622924805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

117 (768.89991760254): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

118 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

119 (!!!!! 1405.0006866455): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

120 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

121 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

122 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

123 (694.99015808105): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 52787.065505981): 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

125 (!!!!! 1788.854598999): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794398 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794398 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 31077.861785889): ( 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 (!!!!! 5352.9739379883): ( 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

128 (!!!!! 6259.9182128906): 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 (452.99530029297): 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

130 (!!!!! 2564.9070739746): 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 (66.041946411133): 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

132 (294.92378234863): 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 (207.90100097656): 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

134 (957.96585083008): 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 (70.095062255859): 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

136 (!!!!! 1985.0730895996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (734.80606079102): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (!!!!! 4090.0707244873): SELECT name FROM jos_deeppockets WHERE id=212

139 (771.04568481445): SELECT name FROM jos_deeppockets WHERE id=212

140 (997.06649780273): 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 (!!!!! 1262.903213501): 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

142 (!!!!! 1404.0470123291): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

143 (247.95532226562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

144 (!!!!! 36978.960037231): TRUNCATE TABLE jos_trademed_module

145 (!!!!! 10814.189910889): 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=294794398 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 11919.975280762): 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=294794398 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (!!!!! 2266.8838500977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (833.98818969727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (!!!!! 1132.9650878906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

150 (602.96058654785): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

151 (!!!!! 5134.105682373): 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

152 (616.07360839844): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

153 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

154 (759.84001159668): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794398 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794398 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (51.021575927734): 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 (41.007995605469): 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)

157 (!!!!! 6790.1611328125): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (663.04206848145): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

159 (216.00723266602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794398 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794398 AND published='1' LIMIT 1

160 (!!!!! 5459.0702056885): select jos_twitters.link from jos_twitters where cat=10

161 (56.028366088867): select jos_facebook.link from jos_facebook where cat=10

162 (44.107437133789): select jos_google_plus.link from jos_google_plus where cat=10

163 (42.915344238281): select jos_linkedin.link from jos_linkedin where cat=10

164 (931.0245513916): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

165 (!!!!! 2300.0240325928): insert into jos_banners_delta values (14615,'2025-08-04 07:22:21','216.73.216.210','view'),(14202,'2025-08-04 07:22:21','216.73.216.210','view'),(14203,'2025-08-04 07:22:21','216.73.216.210','view')

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