To investigate the clinical significance of transvaginal color-pulse Doppler sonography in ovarian tumors, 109 patients were examined at Nagoya University Hospital. Ultrasonographic patterns were classified and the levels of three circulating tumor markers, CA125, CA72-4, and CA19-9, were simultaneously evaluated. In differentiating benign and malignant ovarian tumors, transvaginal color-pulse Doppler and ultrasonographic pattern classification were superior to the tumor markers. Of 49 cases with benign pattern, 45 were benign (91.8%). Of 60 cases with malignant pattern, 24 (40%) were benign and 36 (60%) were malignant or borderline malignant. In this group color-pulse Doppler sonography was the most useful procedure, and sensitivity, specificity, and accuracy were 75.0, 79.2, and 76.7%, respectively. Menopausal status and site of the arterial wave form in the tumor were also important. Transvaginal color-pulse Doppler sonography was a reliable diagnostic method for differentiating ovarian tumors.