Abstract Background: One of the earliest signs of non-palpable breast cancer is microcalcification, which is usually associated with ductal carcinoma in situ (DCIS). Contrast-enhanced spectral mammography (CESM) combines the advantage of mammography in detecting early malignancy in the form of microcalcification, with additional information on lesion characterization, extent and vascularity, which are crucial for surgical management. Aim of Study: Evaluation of the role of contrast-enhanced spectral mammography (CESM) in characterization of suspi-cious breast micro calcification, its diagnostic accuracy and its effect on surgical management. Patients and Methods: This is an observational; case control study that included 31 female patients with suspicious microcalcification, as detected on mammography, categorized as BI-RADS 4 or 5. CESM was performed for all patients. Detailed analysis of the low-energy images for microcalcifi-cations morphology, distributionand degree of enhancement was done. On recombined CESM images,the presence of enhancing lesions (mass or non-mass enhancement), their distributionand patterns of enhancement were also analyzed. Results: This study comprised 31 female patients with suspicious breast microcalcifications on mammography. Among the studied cases, 6/31 (19.4%) cases were benign, while 25/31 (80.6%) cases were malignant. According to CESM, 5/31 (16.1%) cases were probably benign category (BIRADS 2), as they showed no enhancement. Conversely, 26/31 (83.9%) cases were (BIRADS 5) category, out of which one case (3.8%) was pathologically-proven to be benign (False positive). Conclusion: Contrast-enhanced spectral mammography (CESM) is highly accurate in the detection and characterization of breast microcalcification.