Ovarian cancer is the most common cause of death compared to other cancers. The development of ultrasonography has brought great progress in terms of detecting ovarian pathology. This is very important not only in order to detect malignant potential as early as possible but also to choose an adequate approach to treatment in women who have not completed their reproduction. The devastating fact is that around 65% of women with ovarian cancer have advanced disease (stage III/IV) at diagnosis and certainly a much lower survival rate in comparison with patients who have detected stage IA ovarian cancer, whose 5-year survival is over 90% of cases. Due to this fact, for decades, there has been a strong effort to improve the ultrasound findings in order to detect changes in the ovary and to establish markers that enable the recognition of the malignant potential of tumoral changes in the ovary. Three-dimensional/four-dimensional (3D/4D) ultrasound and color Doppler techniques should bring a new quality to the recognition of pathological changes in the ovaries. These new techniques should bring the most accurate preoperative diagnosis of ovarian tumor changes and definitely the intention to detect ovarian cancer at the earliest stage of the disease, which is central to decisions regarding clinical management and surgical planning.