MRI can provide additional soft tissue detail and characterization of ovarian/adnexal lesions and is used as a secondary modality in the O-RADS risk stratification system. The O-RADS MRI lexicon and risk score incorporate terms supported in the literature to describe ovarian/adnexal lesions and assign a risk of malignancy. MRI increases the specificity for the diagnosis of malignancy, due to its ability to detect enhancing solid tissue and can exclude malignancy when there is no enhancing solid tissue.