Purpose: The purpose of this study is to assess the role of dual energy contrast mammography in improvement of the accuracy of sonomammography in evaluation of breast lesions. Material and methods: 34 female patients were enrolled in the study their age ranged between 24-67 years old, mean age is about 49.8. All presented with breast lesion benign and malignant in sono-mammography categorized as BIRADS from 2 to 5. All were subjected to dual-energy contrast enhanced digital mammography, pair of low- and high-energy images were acquired after contrast injection using a modified full-field digital mammography system, then the two images were combined to enhance areas of contrast uptake. The nonionic iodinated contrast agent was administered manually into the contralateral antecubital vein manually. The results were compared to the sono-mammography and cases were histopathologically proven. Results: 28 /34 of our cases were histopathologically proven as malignant and 6/34 was benign. An area of enhancement was depicted on contrast-enhanced digital mammograms (CEDM) in all histologically proven breast carcinomas, compared to 24/28 by ultrasound sonomammography and 20/28 by conventional mammography alone. Our results show that sensitivity was higher for MX+CEDM (70.8 % and 78%) than that was for ultrasound alone (69.9 and 64.3%) or for mammography alone (52.9% and 62.5 %) compared to pathology and BIRADS analysis, respectively with no loss in specificity. Also the good diagnostic accuracy of CEDM+ MX for the detection of breast carcinoma, which here superior to mammography alone and to ultrasound alone or combined both mammogram with ultrasound. Role of DECM was superior in about 70.6 % of cases compared to 20.6 % to that of ultrasound alone, and no difference with adding DECM to conventional sonomammography in 8.8 % of cases. Also accuracy of diagnosis by adding CEDM increased in about 76.5 of cases versus only 23.5% of cases show no difference in accuracy increase using the conventional sonomammography. Compared with mammography associated with breast ultrasound, CEDM had a better diagnostic accuracy mainly due to improved specificity, and better positive and negative predictive values (Positive predictive value about 91.3, negative predictive value 36.5 %). Conclusion: The addition of dual energy contrast enhanced mammography technique to conventional sonomammography can significantly improve diagnostic quality and the cancer detection rate.