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In [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]Ga-PSMA-11, intense focal uptake without MC in a classical location is considered suspicious. The prevalence of focal bone uptake with or without MC on [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]Ga-PSMA-11 PET\/CT remains unclear.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single-center, retrospective study included patients who underwent a [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]Ga-PSMA-11 PET\/CT scan for initial staging or biochemical recurrence (BCR) of prostate cancer between 04\/16\u2009\u2212\u200911\/21, with written informed consent for use of clinical data and adequate follow-up. For each patient with focal PSMA accumulation in the bones, up to three of these lesions were scored based on PSMA-RADS 2.0 and a clinical interpretation of suspicion for malignancy including clinical information was provided. In addition, MC on CT were assessed. A composite reference standard including imaging and clinical follow-up data was used.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 824 patients, 323 met eligibility criteria, with 101 showing PSMA-positive bone lesions. 176 lesions were included, 25% of 61 in the staging cohort had no MC, of which 73% were malignant. In the BCR group, 52% of 115 lesions were without MC, of which 48% were malignant. The sensitivity\/specificity reached with PSMA-RADS 2.0, and MC on CT was 100%\/100%and 78%\/36% for staging, and 83%\/100% and 60%\/72% for BCR, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Focal [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]Ga-PSMA-11 positive lesions without MC on CT are frequent, especially on scans for BCR, with the majority being malignant. Considering PSMA-RADS 4 lesions on [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]Ga-PSMA-11 on staging exams, significantly improves the accuracy. Incorporating clinical information and considering PSMA-RADS 3B can further improve the sensitivity for BCR scans.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-025-07331-x","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T22:27:13Z","timestamp":1750112833000},"page":"231-242","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Assessing the frequency and accuracy of morphologic changes of focal bone lesions on [68Ga]Ga-PSMA-11 PET\/CT in prostate cancer"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4228-1950","authenticated-orcid":false,"given":"Thibika","family":"Sivakumar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3499-8801","authenticated-orcid":false,"given":"Jakob","family":"Heimer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2721-9726","authenticated-orcid":false,"given":"Stephan","family":"Beintner-Skawran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3423-4633","authenticated-orcid":false,"given":"Urs J.","family":"Muehlematter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7815-3048","authenticated-orcid":false,"given":"Michael","family":"Messerli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5690-6375","authenticated-orcid":false,"given":"Noel","family":"Spielhofer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8866-8010","authenticated-orcid":false,"given":"Daniel","family":"Eberli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4849-3292","authenticated-orcid":false,"given":"Martin W.","family":"Huellner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8029-8692","authenticated-orcid":false,"given":"Irene A.","family":"Burger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6964-802X","authenticated-orcid":false,"given":"Alexander","family":"Maurer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"7331_CR1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. 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Approval was granted by the local cantonal ethics committee of Zurich (KEK 2023\u2009\u2212\u200900812).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent (general consent for further use of data) was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Irene. A. Burger has received research grants and speaker honoraria from GE Healthcare, research grants from Vontobel foundation and Bayer, and speaker honoraria from Bayer Health Care, Novartis, Jansen and Astellas Pharma AG and advisory roles for GE Healthcare, Novartis and RatioTherapeutics. Martin W. Huellner received grants and speaker honoraria from GE Healthcare, a fund by the Alfred and Annemarie von Sick legacy and a grant from the clinical research priority program (CRPP) Artificial Intelligence in Oncological Imaging Network of the University of Zurich. Stephan Beintner-Skawran is supported by a grant from the Iten-Kohout Foundation, Switzerland and the Palatin-Foundation, Switzerland.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interests"}}]}}