Our aim: is to assess the applications and possible indications for contrast enhanced digital mammography and its impact on characterization of breast lesions. Materials and methods: 168 patients provided with an overall of 211breast lesions. Written informed consent was obtained. Contrast enhanced digital mammography CEDM was performed by using a digital mammography unit (Seno DS; GE, Buc, France) after injection of 1-1.5 ml/kg of contrast agent (omnipaque) in both CC and MLO views. Findings were correlated with the final pathological results. Results: The average sensitivity was slightly higher for CEDM than for MX (88.99 % versus 88.07%). CEDM had a better diagnostic accuracy mainly due to improved specificity, and better positive and negative predictive values. Conclusions: Dual-energy contrast-enhanced digital mammography as an adjunct to mammography improves diagnostic accuracy compared to mammography alone. Addition of iodinated contrast agent to mammography facilitates the characterization of equivocal breast lesions mainly in dense breasts. Also, it is useful in the clarification of equivocal lesions on conventional imaging, particularly in follow-up after breast-conservative surgery. CEDM with its ability to demonstrate both morphology and tumor enhancement could be beneficial in the assessment of treatment response, accurate lesion size evaluation and can identify multi-focal and multi-centric breast cancer.