Background: Ovarian cancer is the fourth cause of death from cancer in women worldwide. The differentiation of benign from malignant adnexal masses is of great therapeutic significance. Hence, the pre-operative detection of the nature of adnexal mass becomes extremely important for appropriate management. Screening and diagnostic methods for ovarian cancer include pelvic examination, cancer antigen 125 (CA 125) as a tumor marker, transvaginal ultrasound (TVS), and potentially multimarker panels and bioinformatic analysis of proteomic patterns. Aim: Compared the diagnostic performance of the Gynecology Imaging Reporting and Data System (GI-RADS) and the risk of malignancy index (RMI) as regard their ability to evaluate adenexal masses preoperative considering the histopathological definitive diagnosis as the reference