Non-invasive diagnosis of cardiac amyloidosis using ^99mTc-pyrophosphate (PYP) scintigraphy is valuable for differentiating between light chain and transthyretin cardiac amyloidosis. However, there are several pitfalls to be aware of when interpreting PYP planar imaging and single-photon emission computed tomography (SPECT) to assess myocardial PYP uptake. In visual and semi-quantitative assessments using PYP planar imaging, PYP uptake in the blood pool may produce false-positive results. SPECT imaging is essential for differentiating PYP tracer uptake in the myocardium from that in the blood pool, and attention should be paid to the timing of image acquisition and how to create fusion images with CT. This review aims to highlight pitfalls in interpreting PYP imaging and provide tips on how to avoid them.

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