The differential diagnosis of adnexal masses still represents a challenge in spite of the marvelous efforts that have been made to improve the sonographically based diagnosis. There were rapid technological advances in diagnostic ultrasonography in the last decade, with the recent development of threedimensional power Doppler ultrasonography (3DPD). The introduction of 3DPD has opened the possibility to characterize microvasculature of the adnexal masses and objectively assess tumor vascularization. 3DPD allows also an objective measurement of vascularity of a given region of interest by estimating 3 vascular indices (vascularization index [VI], flow index [FI], and vascularization-flow index [VFI]) within such region. The aim of this review article is to evaluate the role of 3DPD in the assessment of adnexal masses vascularity, its ability to discriminate benign masses from malignant ones.