The detection and assessment of ovarian lesions are an important part of gynecological practice. Advance knowledge of whether an overt ovarian mass is malignant may be useful for improving the effectiveness of surgical treatment. Pelvic ultrasonography has been developed continuously, and (in conjunction with biochemical and genetic markers) is being used to achieve these objectives with increasing accuracy. At the same time, knowledge is being accrued about the relationship between ultrasound-derived indices of ovarian tumor vascularity and the molecular aspects of angiogenesis. There is now the exciting prospect that color Doppler imaging with pulsed Doppler spectral analysis could also be used to monitor the development and intermediate effectiveness of novel anticancer treatment.