Background: Adnexal masses are common, resulting in a significant clinical workload related to diagnostic imaging, surgery, and pathology. Most adnexal masses are benign, and most groups can be accurately categorized as benign or malignant on ultrasonography. Imaging plays a vital role in characterizing and risk-stratifying commonly encountered adnexal lesions. Recently, the American College of Radiology (ACR) released the Ovarian-Adnexal Reporting and Data System (ORADS) for ultrasound and subsequently for magnetic resonance imaging (MRI). The goal of the recently developed ACR O-RADS MRI risk stratification system is to improve the quality of imaging reports and the reproducibility of evaluating adnexal lesions on MRI. This review focuses on exploring this new system and its future refinements. Aim: Evaluation of sonographically indeterminate adnexal masses by Ovarian Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) score. Summary: The O-RADS MRI risk score provides a stratification system for assigning the probability of malignancy to adnexal lesions based on MRI features using a stepwise approach. Its widespread use will improve radiologist reports, reproducibility, and communication between radiologists and clinicians/surgeons.