Objective To compare the diagnostic efficacy of ultrasound (US), contrast-enhanced ultrasound (CEUS) and MRI in the differential diagnosis of benign and malignant calcified breast lesions.Methods Sixty patients with calcified breast lesions were examined by US, CEUS and MRI. The characteristics of US and MRI images were analyzed and the corresponding BI-RADS classification was performed to obtain US-BI-RADS and MRI-BI-RADS. The CEUS-BI-RADS classification was obtained according to the US-BI-RADS classification of breast lesions combined with CEUS image characteristics.BI-RADS3 and 4A lesions were judged as benign and BI-RADS4B and above lesions were judged as malignant, and histopathology was used as the gold standard to construct receiver operating characteristic (ROC) curves to assess and compare the diagnostic efficacy of the three imaging methods for benign and malignant breast calcified lesions.Results The misdiagnosis rates of US-BI-RADS, MRI-US-RADS and CEUS-BI-RADS were 18.3%, 15% and 8.3% respectively.The diagnostic accuracy of CEUS-BI-RADS for lesions in 4A and 4B was higher than that of US-BI-RADS and MRI-BI-RADS.CEUS-BI-RADS showed higher sensitivity and AUC (91.3%, 0.915) than US-BI-RADS (87.0%, 0.819) and MRI-BI-RADS (87.0%, 0.851) in differentiating benign from malignant calcified breast lesions, but the differences were not statistically significant (P > 0.05 for all); the specificity and accuracy of CEUS-BI-RADS (91.9%, 91.7%) were higher than those of US-BI-RADS (78.4%, 81.7%) and MRI-BI-RADS (83.8%, 85.0%), and the differences were statistically significant (P < 0.05 for all).Conclusion Both CEUS and MRI are of great value in the differential diagnosis of benign and malignant calcified breast lesions, and the diagnostic efficacy of CEUS is superior to that of MRI.