Contrast enhanced mammography (CEM), utilizes IV contrast to detect tumour neovascularity.رThis functional imaging modality, enables detection of enhancing lesions in the breast, with dual energy digital mammography, including a pair of images for each view. A low energy image which is a standard mammogram and a high energy image for detection of contrast uptake. Then these two images are combined, and glandular tissue subtracted, highlighting contrast uptake, improving cancer detection comparing with mammography and ultrasound.ذCEM, has also demonstrated to have
comparable sensitivity, but higher positive predictive value in cancer detection in comparison with MRI.
Therefore, itcould be usedinstaging of patients with breast cancer, response to treatment post neoadjuvant treatment and screening women at increased risk of breast cancer.
CEM is more cost effective and efficient test comparing with MRI, but involves injection of   iodinated contrast, more  radiation than mammography, which is still within acceptable limits. During this talk we will review techniques, clinical      applications,  pitfalls            and       future
direction of CEM and review few cases.