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The liver is a site of prominent metastasization for many tumours, especially breast and colorectal cancers [1]. Unfortunately, despite many advances in diagnosis and therapy, the prognosis of both primary and secondary hepatic tumours remains poor. Surgery is the most effective approach, but it can often be impracticable due to the anatomic location of the lesions or the massive involvement at presentation. Several treatment modalities both systemic and loco-regional (ethanol injection, radiofrequency ablation, cryoablation, transarterial chemoembolization) have been evaluated [2, 3]. In recent years, Y radioembolization (RE) has emerged as a novel procedure used for the treatment of primary or secondary hepatic lesions. Y, embedded in resin or glass microspheres, is infused directly into the circulation through angiographic catheters placed in the hepatic arteries [4]. Y spheres, once implanted in the liver, can release a significant radiation burden to the neoplastic cells with a relatively low dose to the normal parenchyma due to the different vascularization pattern. To assess tumour response to YRE, Response Evaluation Criteria In Solid Tumours (RECIST) has been largely used [5], but it can present some limitations, since various periand endotumoural processes can occur after the procedure, including oedema, haemorrhage and ring enhancement, which can confound interpretation of response. Besides RECIST, other morphological criteria have been proposed [6]. On the other hand, 2-[F]fluorodeoxyglucose (FDG) PET/CT is a wellestablished diagnostic tool in many oncological scenarios [7]. Although it plays a limited role in the case of non-FDG-avid lesions such as some neuroendocrine tumours and welldifferentiated hepatocellular carcinoma, FDG PET appeared to be useful in detecting metabolic response to Y RE, especially in cases of colorectal and breast cancer metastases to the liver [8, 9]. Regarding the prognostic value of a PET scan, a strict relationship between FDG uptake as measured by the maximum standardized uptake value (SUVmax) and some cellular characteristics of tumours has been reported [10]. Therefore, SUVmax and its changes have been traditionally taken into account as prognostic indicators of tumour response after treatment. Furthermore, PET Response Criteria in Solid Tumors (PERCIST) criteria have been recently introduced to more accurately define the metabolic response of tumours to the therapies [11]. Haug and colleagues published research on the role of FDG PET in predicting survival after Y RE in a cohort of 58 patients with hepatic metastases from breast cancer [12]. FDGPETwas performed at baseline and 3months after the procedure. To evaluate the response of the disease to treatment, the authors applied modified PERCIST criteria. According to the unmodified PERCIST, the change of SUVmax in the two hottest lesions per organ is considered. On the contrary, Haug et al. based their definition of the response on the summed percentage change in the SUVmax in up to five of the most prominent hepatic lesions, demonstrating that response assessed with this approach correlated significantly with survival after Y RE. More recently, Camacho et al. confirmed a significant correlation between overall survival and metabolic response assessed 3 months post procedure by PERCIST criteria in patients with cholangiocarcinoma [13]. It is well known that SUVmeasurements can be affected by many issues, such as the reconstruction algorithm, the scanner O. Bagni : L. Filippi Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy

18F-FDG PET-derived parameters as prognostic indices in hepatic malignancies after 90Y radioembolization: is there a role?