Objective <p>With the continuous increase in the incidence of ovarian tumors in gynecology, the differential diagnosis of benign and malignant ovarian tumors is of great significance for subsequent treatment. The primary aim of this meta-analysis was to systematically evaluate the diagnostic value of MRI in differentiating benign from malignant ovarian tumors.</p> Methods <p>A search was conducted in the PubMed and Web of Science databases to identify diagnostic tests for ovarian tumors using MRI, The search deadline is April 29, 2025. Two reviewers independently screened the literature, extracted data, and assessed the methodological quality of the included studies according to inclusion and exclusion criteria. Subsequently, a meta-analysis was performed using Stata 15.1 software.</p> Results <p>Ultimately, 81 articles were included, encompassing 12,594 patients and 14,023 lesions. Based on the lesion analysis, the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, and diagnostic odds ratio for differentiating benign and malignant ovarian tumors by MRI were 0.92 (95% CI: 0.91–0.94), 0.88 (95% CI: 0.86–0.90), 7.9 (95% CI: 6.6–9.5), 0.09 (95% CI: 0.07–0.11), and 93 (95% CI: 69–125), respectively. The pooled area under the SROC curve was 0.96 (95% CI: 0.94–0.97). Of the 81 included studies, 13 reported diagnostic performance for DWI alone; these were analyzed as a distinct subgroup within the overall meta-analysis. Based on the lesion analysis, the pooled sensitivity, pooled specificity, diagnostic odds ratio, and area under the curve for differentiating benign and malignant ovarian tumors by DWI were 0.88 (95% CI: 0.83–0.92), 0.79 (95% CI: 0.72–0.84), 28 (95% CI: 17–47), and 0.90 (95% CI: 0.87–0.92), respectively. For using MR scoring system (36 studies), pooled sensitivity was 0.94 (95% CI: 0.92–0.96) and specificity 0.90 (95% CI: 0.87–0.93). For contrast-enhanced MRI (69 studies), pooled sensitivity was 0.93 (95% CI: 0.91–0.95) and specificity 0.89 (95% CI: 0.86–0.91). However, whether dynamic contrast-enhanced (DCE) was performed during MRI diagnosis of benign and malignant ovarian tumors had little effect on the pooled sensitivity, while the pooled specificity of studies that performed DCE might be slightly higher than those that did not.</p> Conclusions <p>MRI plays a crucial role in differentiating between benign and malignant ovarian tumors, and DWI can serve as an auxiliary diagnostic tool, used concurrently with conventional MRI, while the diagnostic efficacy of DCE and non-DCE is similar. Prospective studies using MRI scoring systems and sample sizes exceeding 100 also show better diagnostic performance.</p>