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Enhanced Ultrasound Superior to MRI for Diagnosing Certain Liver and Kidney Tumors

By MedImaging International staff writers
Posted on 27 Feb 2023

Image: Contrast-enhanced ultrasound vs. conventional ultrasound image (Photo courtesy of ICUS)

Contrast-enhanced ultrasound (CEUS) is a non-invasive imaging tool that is routinely used across the world to identify and characterize cancers, diagnose heart and vascular disease, monitor chronic gastro-intestinal diseases and therapy. Ultrasound contrast agents are administered intravenously to enhance the images produced by ultrasound scans, enabling the visualization of abnormal microvascular blood flow patterns in real time. Now, two new studies have revealed that CEUS is more accurate and reliable than MRI for examining certain liver and kidney nodules.

The two new studies were highlighted by the International Contrast Ultrasound Society (ICUS, Chicago, IL, USA; www.icus-society.org), a non-profit medical society dedicated to advancing the medically appropriate use of CEUS to improve patient care and outcomes. In the liver CEUS study, which followed 196 patients for two years, the researchers found that CEUS scans are at least equivalent if not superior to MRI for evaluating these liver lesions, and CEUS should be the first investigation for nodules found on surveillance for liver cancer. The study showed that CEUS offers superior sensitivity when compared to MRI (81% vs. 64%) for the diagnosis of malignancy, without compromising specificity (92% vs. 93%). In addition, CEUS was more likely than MRI to reproduce and characterize the nodule found on screening (97% vs. 78.5%). The liver study represents the first prospective comparison of CEUS and contrast-enhanced MRI for assessment of newly-discovered liver nodules. Based on these findings, the researchers have called upon the American Association for the Study of Liver Diseases (AASLD) to include CEUS in its liver imaging guidelines, along with MRI and CT. However, MRI still remains an essential tool for managing patients with malignant tumors, particularly for staging these tumors prior to treatment, according to the researchers.

“We found that CEUS is a better and less expensive first-step evaluation for newly-discovered liver nodules,” said Dr. Stephanie Wilson, principal investigator of the liver CEUS study. “CEUS found malignant or pre-malignant diagnoses that would likely have been missed or delayed if we had not used CEUS in these patients. In addition, CEUS quickly and reliably identified benign lesions and pseudo-lesions, sparing these patients the costs and risks associated with unnecessary downstream testing and procedures.”

Meanwhile, the kidney CEUS study reviewed clinical data over a 10 year period to assess the accuracy of CEUS diagnoses of benign kidney nodules in 341 patients. Their blinded analysis found that none of the CEUS diagnoses changed during that period.

“Our data confirm that when CEUS determines a kidney mass is benign, the mass is benign and no further follow up is needed - sparing the patient from unnecessary downstream tests, anxiety and costs,” according to Dr. Richard G. Barr, the lead author of the kidney CEUS study. “It is important to remember that ultrasound contrast agents do not contain iodinated dye and do not harm the kidneys, making CEUS the examination of choice for patients with renal insufficiency.”

“In addition, CEUS allows for improved visualization of enhancement patterns in real time, the thin slice thickness of CEUS allows for evaluation of small nodules, multiplanar imaging allows for improved visualization and confirmation of enhancement, and multiple doses may be used during the same examination to provide an opportunity to image the lesion thoroughly,” Dr. Barr added. “Further, due to radiation exposure associated with CT, we believe CT should not be used as the first line imaging modality for assessing cystic lesions that are most probably benign in character.”

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63 (70.810317993164): 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

64 (506.16264343262): SELECT fid FROM jos_deeppockets WHERE id=294796347 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294796347 AND published='1' LIMIT 1

65 (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`

66 (44.822692871094): select jos_twitters.link from jos_twitters where cat=10

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

68 (49.114227294922): select jos_google_plus.link from jos_google_plus where cat=10

69 (35.04753112793): select jos_linkedin.link from jos_linkedin where cat=10

70 (42.200088500977): SELECT fid FROM jos_deeppockets WHERE id=294796347 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294796347 AND published='1' LIMIT 1

71 (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`

72 (328.77922058105): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294796347 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (232.93495178223): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294796347 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (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`

75 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (46.968460083008): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294796347 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (28.848648071289): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294796347 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (36.001205444336): 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`

92 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

107 (38.14697265625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

108 (54.121017456055): 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=294796347 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (44.107437133789): 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=294796347 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

111 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

112 (407.93418884277): 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=294796347 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (357.86628723145): 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=294796347 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (50.067901611328): 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=294796338 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (324.96452331543): 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=294796338 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

116 (579.1187286377): 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

117 (366.9261932373): 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

118 (78.201293945312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

119 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

120 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

121 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

122 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

123 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

124 (257.96890258789): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 17507.076263428): 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

126 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

127 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

128 (367.87986755371): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294796347 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294796347 AND type='deeppockets_item' AND published='1' LIMIT 1

129 (!!!!! 477524.04212952): ( 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

130 (92.029571533203): ( 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

131 (81.062316894531): 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

132 (43.153762817383): 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

133 (61.988830566406): 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

134 (39.815902709961): 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

135 (40.054321289062): 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

136 (36.001205444336): 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

137 (689.02969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (480.17501831055): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (195.98007202148): SELECT name FROM jos_deeppockets WHERE id=212

140 (32.901763916016): SELECT name FROM jos_deeppockets WHERE id=212

141 (450.13427734375): 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 (492.81120300293): 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

143 (428.91502380371): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

144 (169.03877258301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

145 (!!!!! 9032.9647064209): TRUNCATE TABLE jos_trademed_module

146 (169.99244689941): 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=294796347 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (61.03515625): 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=294796347 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (914.09683227539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (81.777572631836): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

151 (60.796737670898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

152 (!!!!! 2506.9713592529): 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

153 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

154 (42.200088500977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

155 (41.961669921875): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294796347 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294796347 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (385.99967956543): 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=0 or channel_id is null)

157 (32.901763916016): 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=0 or channel_id is null)

158 (31.948089599609): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (571.96617126465): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

160 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796347 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796347 AND published='1' LIMIT 1

161 (245.09429931641): select jos_twitters.link from jos_twitters where cat=10

162 (33.855438232422): select jos_facebook.link from jos_facebook where cat=10

163 (93.936920166016): select jos_google_plus.link from jos_google_plus where cat=10

164 (118.01719665527): select jos_linkedin.link from jos_linkedin where cat=10

165 (355.95893859863): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

166 (!!!!! 2150.0587463379): insert into jos_banners_delta values (14615,'2025-04-30 15:58:46','3.133.115.157','view'),(14202,'2025-04-30 15:58:46','3.133.115.157','view'),(14203,'2025-04-30 15:58:46','3.133.115.157','view')

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