Proper oncological treatment of patients with adnexal masses depends on appropriate preoperative discrimination between benign and malignant ovarian tumors. There are suggestions that appropriate malignancy risk estimation could be achieved by ultrasound assessment of adnexal mass echomorfology by an experienced sonographer. Evaluating morphologic characteristics of the adnexal masses, in so called pattern recognition, features like presence of mixed consistency or multilocular components, septa or excrescence could differentiate benign from malignant neoplasms. Doppler examination of intratumoral blood flow velocity waveforms, with resistance and pulsatility indexes determination, raises confidence in achieving the correct diagnosis. Therefore, detailed ultrasonographic examination with Doppler scan should always be performed in all patients with adnexal masses. For more accurate preoperative triage calculation of RMI is advisable.