Title: Evaluation of Contrast-enhanced Mammography and Development of Flowchart for BI-RADS Classification of Breast Lesions. Introduction: This study aims to evaluate contrast-enhanced digital mammography (CEM) and compare breast lesions on CEM and breast magnetic resonance imaging (MRI) using five morphological and dynamic characteristics of the lesions. We propose a flowchart, or a scoring system, for classifying breast lesions in the BI-RADS system on CEM, based on the existing scoring system for classifying breast lesions in the BI-RADS system on MRI, called the Kaiser score (KS). Materials and methods: The study included 81 participants (both women and men of average age 61.6 ± 11.8 years) who exhibited pathological opacities on digital mammography (MG) findings. Breast ultrasound (US), CEM, MR, and Core-Needle Biopsy (CNB) of suspicious lesions were performed on the participants. Malignant lesions were confirmed by biopsy in 58 participants, while benign lesions were confirmed in 23 participants. KS was calculated for all lesions. Results: In the patients with malignant lesions, the MRI-derived KS was 9 (IQR 8–9), its CEM equivalent was 9 (IQR 8–9), and BI-RADS was 5 (IQR 4–5). In patients with benign lesions, MRI-derived KS was 3 (IQR 2–3), its CEM equivalent was 3 (IQR 1.7–5), and BIRADS was 3 (IQR 0–4). There was no significant difference between the ROC-AUC of CEM and MRI (p = 0,749). Conclusion: There were no significant differences in Kaiser score results between breast CEM and MRI. The scoring system that we propose for classifying breast lesions in the BI-RADS system on CEM can be used in clinical practice, much as the existing scoring system for breast MRI.