Objective: To investigate the value of acoustic radiation force impulse (ARFI) elastography combined with blood flow parameters in differential diagnosis of benign and malignant ovarian tumors. Methods: Eighty patients with ovarian tumors admitted to the hospital from January 2022 to December 2024 were selected. All of them underwent ARFI elastography and color Doppler flow imaging. With pathological examination as the gold standard, the patients were divided into benign group and malignant group. The shear wave velocity (SWV) and blood flow parameters [pulsatility index (PI) and resistance index (RI)] were compared between the two groups. The ROC curve was used to analyze the value of each parameter and combination of parameters in differential diagnosis. The parameters of patients at different International Federation of Gynecology and Obstetrics (FIGO) stages in the malignant group were compared. Results: Pathological examination found 53 benign cases and 27 malignant cases (7 cases in FIGO stage I, 9 cases in FIGO stage II, 6 cases in FIGO stage III and 5 cases in FIGO stage IV). SWV of the malignant group was significantly higher than that of the benign group. PI and RI were lower than those of the benign group (P<0.05). ROC curve analysis showed that the areas under the curve of SWV, PI, and RI were greater than 0.70. The area under the curve and sensitivity of combined diagnosis (0.982 and 98.00%) were significantly higher than those of diagnosis with each parameter (P<0.05). For patients with ovarian cancer, as FIGO stage increased, SWV increased, and PI and RI decreased (P<0.05). Conclusion: The combination of ultrasound elastography and blood flow parameters (SWV, PI and RI) demonstrates good efficacy in identifying the nature of ovarian tumors. Besides, these parameters are associated with FIGO staging of ovarian cancer.