Background: Sonography has been used as adjunct to mammography to increase the accuracy during screening. Breast MRI is the most sensitive tool in imaging of breast cancer. Diffusion weighted imaging (DWI) does not depend on intra-venous contrast injection and is currently investigated to be added to screening of females with dense beast. Diffusion tensor imaging is a rising technique that can be of value in breast imaging. Objective: The aim of the current study was to evaluate the diagnostic accuracy of MRI and MRI with diffusion techniques and compare it with sonomammography which is the routine exam for dense breasts. Patient and methods: A diagnostic study was carried out and included 88 patients (age range 40-67 years) referred to Radiology Department of Mansoura University Hospital. All patients were subjected to proper history taking, sonomammography, conventional, contrast enhanced, diffusion weighted MRI and DTI. This study was using a 7-11 MHz hand held ultrasound, full field digital mammography and 1.5 T MRI scanner. Results: The sensitivity of sonomammography was found to be 71%, with a specificity of 90%, a Positive Predicative Value (PPV) of 89%, a Negative Predictive Value (NPV) of 93%, and an overall accuracy of 91%. However, the sensitivity and specificity of sonomammography were significantly lower than those of MRI with DWI and MRI with DTI, as indicated by the lower values of these parameters (P<0.001) for sonomammography compared to MRI with DWI and DTI. Specifically, MRI with DWI had a sensitivity of 82% and a specificity of 85%, with a PPV of 91.4% and a NPV of 89.5%, resulting in an overall accuracy of 90.7%. Similarly, MRI with DTI had a sensitivity of 82% and a specificity of 90%, with a PPV of 94.3% and an NPV of 94.7%, resulting in an overall accuracy of 94.4%. Conclusion: MRI with diffusion techniques is a more reliable imaging modality in mammographically dense breasts, with higher sensitivity and specificity.