The basis of improved sonographic detection of ovarian malignancies with microbubbles is the depiction of the tumor microscopic (capillary) vascular network. Beginning with the seminal studies by Folkman, it was shown that tumors require a vascular network derived from the host vasculature for their growth and potential metastatic spread [ 2 ]. The vessels that supply nutrients to tumors have irregular branching points and caliber. They form clusters in areas of tumor growth and have numerous arteriovenous malformations. Typically, tumors have rim of vessels, whereas the center of AbstractThe morphologic assessment of ovarian masses using gray scale, 2D/3D, and color Doppler sonography has been shown to be moderately (80-90 %) accurate in distinguishing benign from malignant ovarian masses. The desire to improve the accuracy of early detection of ovarian cancer using sonography has driven to investigate the clinical application of contrast-enhanced transvaginal sonography (CE-TVS). In this chapter will be reviewed the CE-TVS as well as our experience in this fi eld. KeywordsOvarian cancer • Ultrasound • Transvaginal ultrasound • Contrast-enhanced transvaginal ultrasound