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Dual Energy CT Used to Detect Gout

By MedImaging International staff writers
Posted on 17 Jun 2009

The most effective method of diagnosing gout is to aspirate the joint to obtain fluid to verify the presence of monosodium urate crystals (uric acid). More...

Up to now, computed tomography (CT) imaging has played a limited role in the evaluation of gout, since conventional CT systems cannot reliably confirm deposits of uric acid. However, a study gives rise to speculation that dual-energy computed tomography (DECT) could radically change the diagnosis of this disease.

DECT enables fast, noninvasive examinations, and based on initial evaluations, has the potential to surpass the invasive gold standard and clinical examination in terms of effectiveness. Investigations have confirmed the high sensitivity of the DECT method in detecting uric acid deposits. The scientists in this study, from Vancouver General Hospital (BC, Canada), utilized the Somatom Definition CT scanner, developed by Siemens Healthcare (Erlangen, Germany), for their study. This system is the only CT scanner worldwide that features two X-ray tubes capable of simultaneously producing different energies.

Gout is the most widespread form of crystal arthopathy and the most common inflammatory joint disease in men. It is caused by the deposition of uric acid crystals in joints and predominantly occurs among men. 2.1 million people in the United States and some 1.5 million people in Germany are currently afflicted by this painful, destructive disease. Furthermore, due to unhealthy eating habits, these figures are constantly increasing.

The classical symptoms of gout are painful, visibly swollen joints. Gout is nevertheless difficult to diagnose, since quite a few diseases, for example, various forms of arthritis, have similar symptoms. While imaging techniques can help to locate gout lesions, the specificity of X-ray, single-source CT, magnetic resonance imaging (MRI), and ultrasound is not sufficient to definitively confirm a diagnosis. Certainty can be achieved only by verifying the presence of monosodium urate crystals, also called uric acid deposits (tophi), in and around the joint. This is achieved by aspirating the joint with a needle to remove the fluid, which is then microscopically analyzed under polarized light. A joint puncture may be difficult with acutely inflamed joints, since the amount of fluid available may not be sufficient for this purpose. Furthermore, some anatomic regions are difficult to access, for example in the spinal region. A noninvasive diagnostic technique is therefore extremely desirable.

The prospect of a fast, safe and noninvasive diagnosis of gout using DECT has generated great interest in Canada. In collaboration with Siemens, Dr. Savvas Nicolaou, director of emergency radiology at Vancouver General Hospital and Associate Professor at the University of British Columbia in Vancouver, and both his radiology and rheumatology colleagues developed a dual-energy algorithm for identifying uric acid deposits.

The Canadian scientists used a Somatom Definition for their trials. The team performed scans at different energies to determine the attenuation values of uric acid deposits. Siemens used these data to develop a new dual-energy protocol for gout that now can be used by any physician. The software algorithm used to detect gout via DECT is based on the realization that the CT values of uric acid deposits are lower, for instance, than those of calcium if scans are performed at different energies (80 and 140 kilovolts). Through color coding of the different attenuation values, it then becomes possible to recognize monosodium urate crystals on the clinical CT image: The uric acid crystals indicating gout are, for example, color coded in red, while other bone formations and calcium are displayed in blue. The commercial version of the Siemens application is called Syngo DE Gout.

In an additional study, Dr. Nicolaou and his colleagues investigated whether DECT can be used effectively to confirm the presence of gout tophi, whether DECT is better than the conventional clinical examination, such as in detecting subclinical urate deposits, and whether this modality can clarify cases of doubt as problem solving tool. Ten patients were recruited who already had been diagnosed with gout by means of joint puncture with aspiration of synovial fluid and 10 control patients that did not have gout clinically. The patient records of all patients were analyzed and all patients underwent a complete rheumatologic examination and DECT. The evaluation of the DECT images was performed by two radiologists working independently of one another.

This study showed that the DECT images of all patients proven to have gout yielded correspondingly positive findings in the aspirated joints. The DECT images of the control group all showed negative findings. "Our findings indicate that deposits of monosodium urate crystals can be detected subclinically more efficiently using DECT than with the traditional clinical examination,” said Dr. Nicolaou.

The fact is that more areas involved with gout were found overall per DECT than through the other clinical examination, i.e., 200 sites with DECT versus 53 sites clinically, i.e., four times more foci were revealed with DECT (p < 0.05). Furthermore, it has become evident that DECT can detect the presence of gout in hands, wrists feet, ankles, and knees significantly better than the traditional clinical examination. DECT did not achieve significantly better results in the detection of gout in the elbow.

Moreover, the study also provided new information on the presence of subclinical tophi and the accumulation of monosodium urate crystal deposits in clinically challenging anatomic regions. "To our surprise, the study showed that uric acid can be initially deposited in tendons and ligaments near and within the knee joint, ankle joint, wrist, i.e., in the collateral ligament/cruciate ligament and deep flexor tendons of the wrist,” noted Dr. Nicolaou. "This is very important to know, since these deposits can increase the susceptibility of tendons and ligaments for tears. If we are able to detect the disease in an early stage, we can initiate a treatment to prevent destruction of the tendons and ligaments and joints where subclinical tophi are present. DECT is a promising new technique, that can in a reliable, noninvasive fashion confirm the presence of gout tophi subclinically that surpasses the sensitivity of clinical examinations, provides information on the patient's disease burden and enables differentiation from other diseases. This technique may be used for monitoring treatment success and can be used to resolve unclear cases,” concluded Dr. Nicolaou.

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Vancouver General Hospital
Siemens Healthcare

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52 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

53 (280.14183044434): SELECT name FROM jos_deeppockets WHERE id=294723974 LIMIT 1

54 (223.87504577637): SELECT name FROM jos_deeppockets_archive WHERE id=294723974 LIMIT 1

55 (59.127807617188): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

56 (59.127807617188): 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=294723974 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (393.15223693848): 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=294723974 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 1322.9846954346): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

59 (70.810317993164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

60 (133.99124145508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

61 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

62 (176.90658569336): 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 (699.04327392578): SELECT fid FROM jos_deeppockets WHERE id=294723974 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294723974 AND published='1' LIMIT 1

64 (61.988830566406): 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=211 ORDER BY `ordering`

65 (74.148178100586): select jos_twitters.link from jos_twitters where cat=10

66 (51.021575927734): select jos_facebook.link from jos_facebook where cat=10

67 (41.007995605469): 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 (57.93571472168): SELECT fid FROM jos_deeppockets WHERE id=294723974 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294723974 AND published='1' LIMIT 1

70 (44.107437133789): 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=211 ORDER BY `ordering`

71 (416.99409484863): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294723974 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (408.88786315918): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294723974 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (48.87580871582): 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 (59.127807617188): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (56.982040405273): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294723974 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (57.93571472168): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294723974 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (55.074691772461): 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 (82.969665527344): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (88.214874267578): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

106 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

107 (82.015991210938): 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=294723974 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (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_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=294723974 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

110 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

111 (73.909759521484): 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=294723974 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (622.03407287598): 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=294723974 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (719.07043457031): 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 (725.98457336426): 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 (185.01281738281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

116 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

117 (106.8115234375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

118 (65.803527832031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

119 (389.09912109375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

120 (181.91337585449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

121 (115.15617370605): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

122 (100.13580322266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

123 (478.02925109863): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 62789.916992188): 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 (489.95018005371): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294723974 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294723974 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 16694.068908691): ( 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 (116.82510375977): ( 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 (45.061111450195): 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 (31.948089599609): 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 (42.915344238281): 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 (28.133392333984): 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 (292.06275939941): 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 (38.14697265625): 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 (32.186508178711): 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 (28.133392333984): 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 (353.09791564941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (260.1146697998): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (40.054321289062): SELECT name FROM jos_deeppockets WHERE id=211

139 (28.133392333984): SELECT name FROM jos_deeppockets WHERE id=211

140 (600.09956359863): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (504.0168762207): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

143 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

144 (!!!!! 5846.9772338867): TRUNCATE TABLE jos_trademed_module

145 (!!!!! 1230.9551239014): 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=294723974 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (102.99682617188): 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=294723974 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (319.9577331543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (140.19012451172): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

150 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

151 (!!!!! 1203.0601501465): 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 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

153 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

154 (31.948089599609): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294723974 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294723974 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (29.802322387695): 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=211 or channel_id is null)

156 (26.941299438477): 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=211 or channel_id is null)

157 (29.087066650391): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (!!!!! 4071.9509124756): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

159 (105.85784912109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723974 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723974 AND published='1' LIMIT 1

160 (44.107437133789): select jos_twitters.link from jos_twitters where cat=10

161 (38.14697265625): select jos_facebook.link from jos_facebook where cat=10

162 (34.093856811523): select jos_google_plus.link from jos_google_plus where cat=10

163 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

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Dual Energy CT Used to Detect Gout

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