Abstract Background: Breast cancer is estimated to be the most common cancer among Egyptian females and accounts for the leading cause of cancer related mortality. Contrast enhanced mammography is an emerging technique that combines intra-venous iodinated contrast administration with digital mam-mography. CEM improves the sensitivity for breast cancer detection without decreasing the specificity owing to higher contrast and better lesion delineation. Aim of Study: To investigate the usefulness of contrast enhanced mammography in the assessment of indeterminate (BIRADS 4) breast lesions. Patients and Methods: The study was performed on 32 female patients discovered to have BIRADS 4 breast lesions on conventional mammography and/or breast ultrasonography. All patients were injected with non ionic contrast media. Examination was then performed on a digital mammography machine adapted for CESM. Results: CEM correctly upgraded 22/22 histopathologically proven malignant lesions from BIRADS 4 to 5. 18/22 benign lesions were correctly downgraded from BIRADS 4 to 3, while 4 benign lesions were incorrectly upgraded to a BIRADS 5 by CEM. No malignant lesions were incorrectly downgraded to BIRADS 3 by CEM. Overall performance of CEM was a sensitivity of 100%, a specificity of 81.8%, a PPV of 84.6%, a NPV of 100% and an accuracy of 90.9%. Conclusion: CEM is a useful and reliable tool that can increase diagnostic confidence when evaluating indeterminate breast lesions.