Purpose To improve the accuracy of the preoperative diagnosis of ovarian cystadenofibroma (CAF) or adenofibroma (AF). Methods Clinical symptoms, laboratory results, imaging features, and pathological results of 11 patients with 11 histologically proven ovarian CAF/AF were reviewed retrospectively. The computed tomography (CT) and magnetic resonance imaging (MRI) features of the tumor including location, number, size, internal characteristics, CT density or MRI signal intensity, enhancement

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... rmance, lymphadenopathy, and amount of ascites were comprehensively evaluated. Results With regard to the clinical findings, results of serum cancer antigen 125 (CA125), cancer antigen 199 (CA199), and other laboratory tests were normal in most cases (81.8%, 9/11). The imaging features of the 11 lesions were as follows: unilateral occurrence, well-defined boundary, round or roundish, unilocular (63.6%, 7/11), cystic mass (81.8%, 9/11), multilocular (27.3%, 3/11), black sponge sign (18.2%, 2/11), carpet sign (81.8%, 9/11), residual ovary sign (45.5%, 5/11), papillary nodule clusters (45.5%, 5/11), and small vesicle with an acute angle to the inner cyst wall (18.2%, 2/11). The signal intensity of the solid component was isointense or hypointense on T2-weighted imaging and hypo intense on diffusion-weighted imaging. The CT value of the lesions ranged from 21 Hounsfield units (Hu) to 45 Hu. A slight to moderate enhancement degree occurred in more than half of the lesions (54.5%, 6/11). No or a small amount of ascites was present in these cases. Histologic examination revealed SCAF (45.5%, 5/11), SAF (27.3%, 3/11), and borderline CAF/AF (27.3%, 3/11). No necrosis, hemorrhage, or calcification was observed in any of these masses. Conclusion Ovarian CAF/AF usually mimics malignancy, demonstrating a cystic mass combined with solid component on CT or MR images. The integrity of case data including laboratory results and imaging features can help radiologists make an accurate preoperative diagnosis. No or a small amount of ascites may narrow the differential diagnosis.