الفهرس 
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Abstract
Back ground Breast density primarily affects mammographic sensitivity by a masking phenomenon; as the dense tissue may obscure an underlying malignancy. Breast density has been reported to be a strong independent risk factor for breast cancer, with evidence suggesting that women having heterogeneously dense breasts (ACR C) have a 1.2 fold increased risk of cancer breast, and women with extremely dense breasts (ACR D) have a
2.1 fold increased risk, as compared to the average patient’s risk. Although standard mammography is considered to be the best screening tool available, it is not perfect especially in dense breasts.
Aim of this study is to The aim of this work is to study the impact of breast Ultrasound versus Contrast Enhanced Spectral Mammography in the detection and diagnosis of lesions in the mammography dense breasts.
Patients & methods: the study was performed over 50 patients. All patients underwent ultrasound and contrast enhanced mammography
Results: our review of results demonstrated that CESM is superior to ultrasound in detection and characterization of lesions in dense breasts with higher accuracy. Sensitivity was higher in CESM compared to ultrasound with exactly the same specificity.
Conclusion: CESM revealed superior diagnostic accuracy and higher sensitivity than ultrasound and hence, permitted better detection of malignant lesions.