Purpose: To elucidate the diagnostic value of contrast enhanced mammography in comparison with dynamic MRI in cases of breast cancer recurrence and to correlate with available clinical data, histopathology findings and/or follow up. Methods: 30 patients were enrolled in this study. The age ranged between31-68 years old. Patients were referred from the General Surgery or Oncology Departments in the period from August-2015 until April-2018. The patients underwent full history taking and clinical examination and CESM and breast magnetic resonance image (BMRI) examination. Finally US guided biopsy was performed. Results: Contrast enhanced spectral mammography (CESM) showed slightly lower sensitivity (88.89%) and overall accuracy (86.67%) than BMRI (96.30% and 90% respectively). However specificity was higher in CESM (66.67%) than that of BMRI (33.33%). Conclusion: In spite of the lower sensitivity of the CESM compared to MRI, the CESM appeared to be a suitable, easy, more comfortable, low cost and fast alternative to MRI in early detection of breast cancer recurrence specially for patients with contraindications to MRI.