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<b>Background:</b> The aim of this study is to evaluate the correlation between background parenchymal enhancement (BPE) and various patient-related and technical factors in recombined contrast-enhanced spectral mammography (CESM) images. <b>Material and Methods:</b> We assessed CESM images from 62 female patients who underwent CESM between May 2017 and October 2019, focusing on factors influencing BPE. A total of 235 images, all acquired using the same mammography machine, were analyzed. A region of interest (ROI) with a standard size of 0.75 to 1 cm² was used to evaluate the minimal, maximal, and average pixel intensity enhancement. Additionally, the images were qualitatively assessed on a scale from 1 (minimal BPE) to 4 (marked BPE). We examined correlations with body mass index (BMI), age, hematocrit, hemoglobin levels, cardiovascular conditions, and the amount of pressure applied during the examination. <b>Results:</b> Our study identified a significant correlation between the amount of pressure applied during the examination and the BPE (Spearman’s ρ = 0.546). Additionally, a significant but weak correlation was observed between BPE and BMI (Spearman’s ρ = 0.421). No significant associations were found between BPE and menopausal status, cardiovascular preconditions, hematocrit, hemoglobin levels, breast density, or age. <b>Conclusions:</b> Patient-related and procedural factors significantly influence BPE in CESM images. Specifically, increased applied pressure and BMI are associated with higher BPE.