ObjectiveTo summarize the basic principles, techniques, and clinical applications of contrast-enhanced spectral mammography (CESM).MethodsThe literatures about CESM in recent years were collected to make an review.ResultsCESM had a low energy image and subtracted image, could provide both morphology information and enhancement characteristics of breast lesions. CESM had been adopted in some clinical applications, such as problem solving of inconclusive findings, preoperative evaluation of tumor extent, and assessing residual malignancy after neoadjuvant systemic therapy.ConclusionCESM has equal clinical value with MRI, but it needs short examination time, and lead to easy accessibility and fewer cost, which might be a suitable alternative in the department that do not have MRI.