The objective of the study was assessment of the adnexal tumor vascularization with transvaginal color and pulsed Doppler sonography. Vessel location, its arrangement, and pulsed Doppler waveform characteristics were used to distinguish benign from malignant vascularity. The study was designed as a retrospective one in which sonographic and personal records of 254 women were investigated. The significance between ultrasonic results was analyzed by difference between group means and pooled estimate of variance. Results showed that peripheral and pericystical location with single vessel displayed and resistance index above 0.40 were highly associated with benign ovarian lesions. Blood vessels located in the centar, septum, and papillary projection of the tumor with diffuse dispersed vascular arrangement and resistance index below 0.41 were highly correlated with malignancy. There were no statistically significant differences in blood flow velocities observed at different vascular locations and vessel arrangement between benign and malignant ovarian masses. In conclusion, in addition to resistance index analysis of blood flow, vascular arrangement and location are important for accurate discrimination of benign from malignant ovarian lesions.