To the Editor: We have carefully read the Letter by Dr. Surov [1] and wish to thank him for his interest in our paper. The letter raises some interesting issues that merit discussion. First, Dr. Surov argues that the frequency of skeletal muscle metastases (SMMs) in our case series is higher (2.6 %) than in previously reported data by other authors. The prevalence of SMMs in cancer patients has mainly been reported in postmortem studies, with highly variable estimates. In addition, apart from anecdotal case reports, this topic has not been adequately addressed in real-life clinical practice, at least in our opinion. Data from retrospective case series including different primary tumors also contribute to incomparable results due to differences in epidemiological and clinical/methodological settings. Dr. Surov [2] states that frequency of lung-cancer-related SMMs occurred only in the 0.84 % of cases in his retrospective evaluation of 5,170 patients suffering from a wide variety of primary malignancies, thus suggesting lung cancer to be a rare cause of SM involvement compared with other tumors. This, along with previous observations, is not really in contrast with our experience, which may help the scientific community further delineate this scenario. Indeed, while being a retrospective study, ours was reinforced by the strategy of analyzing a single primary tumor in a large cohort of patients within a given time, which is disease presentation at initial staging. We believe that taken together, these observations expose the need for additional efforts in larger, tailored prospective studies [3]. Dr. Surov [2] states that we described only two patterns of muscle metastases in lung cancer patients, visualized on multidetector computed tomography (MDCT) after i.v. injection of contrast medium, that were type I and II lesions, in agreement with SMMs classification provided in his retrospective analysis. To our knowledge, there are no literature data addressing the type of SM involvement in a given tumor setting for comparison. Therefore, data reported in our case series are complementary to those reported by Dr. Surov in his retrospective analysis. From a speculative point of view, it may be hypothesized that type III, IV, and V lesions, respectively, characterized by local bleeding, calcification, and infiltration, may be related to tumors of different origin and biology. However, this issue remains to be demonstrated. Unlike literature data, we also described a higher prevalence of type II lesions, but no definite comparison was feasible. To date, among the socalled target-like lesions, which are SMMs with ring-like enhancement and central hypoattenuation, we also reported the occurrence of large abscesses with a significant necrotic component in the 24 % of cases [3]. These findings may be classifiable as a subgroup of type II lesions. Again, the same consideration as given to SMM type should be done when looking at the frequency distribution of SM sites involved. Despite the fact that we described a higher prevalence of gluteal muscle involvement in comparison with data by Dr. Surov, overall, our observations are in line with previous literature reports. More evidence addressing This comment refers to the article available at doi:10.1007/s11604014-0299-8.