Objective To compare the value of ultrasound ovarian-adnexal imaging reporting and data system (O-RADS) and International Ovarian of Tumor Analysis (IOTA) simpler ules (SR) ultrasonographic stratification in the diagnosis of adnexal masses. Methods Routine ultrasound images of 159 cases of ovarian mass confirmed by pathology were retrospectively analyzed,and O-RADS and IOTA SR were used for classification evaluation, respectively, to compare the efficacy of the two methods in the diagnosis of benign and malignant ovarian masses. Results The area under receiver operating characteristic (ROC) curve of O-RADS and IOTA SR for the diagnosis of ovarian mass was 0.863 and 0.847. The sensitivity and specificity of O-RADS for the diagnosis of benign and malignant ovarian masses were 95.08% and 77.55%, and the sensitivity and specificity of IOTA SR for the diagnosis of benign and malignant ovarian masses were 90.16% and 74.49%. Conclusion Compared with IOTA SR, O-RADS has higher diagnostic efficiency , which can reduce the misdiagnosis rate of benign ovarian masses.