diff --git a/fastapi_mcp/openapi/convert.py b/fastapi_mcp/openapi/convert.py
index 22e5c5e..e212d26 100644
--- a/fastapi_mcp/openapi/convert.py
+++ b/fastapi_mcp/openapi/convert.py
@@ -259,8 +259,21 @@ def convert_openapi_to_mcp_tools(
             if required_props:
                 input_schema["required"] = required_props
 
+            # Build tool annotations
+            try:
+                annotations = operation["x-mcp-annotations"]
+            except KeyError:
+                annotations = None
+            else:
+                annotations = types.ToolAnnotations(**annotations)
+
             # Create the MCP tool definition
-            tool = types.Tool(name=operation_id, description=tool_description, inputSchema=input_schema)
+            tool = types.Tool(
+                name=operation_id,
+                description=tool_description,
+                inputSchema=input_schema,
+                annotations=annotations,
+            )
 
             tools.append(tool)
 
diff --git a/tests/fixtures/simple_app.py b/tests/fixtures/simple_app.py
index 5d8298a..1486cbf 100644
--- a/tests/fixtures/simple_app.py
+++ b/tests/fixtures/simple_app.py
@@ -16,7 +16,18 @@ def make_simple_fastapi_app(parametrized_config: dict[str, Any] | None = None) -
         Item(id=3, name="Item 3", price=30.0, tags=["tag3", "tag4"], description="Item 3 description"),
     ]
 
-    @app.get("/items/", response_model=List[Item], tags=["items"], operation_id="list_items")
+    @app.get(
+        "/items/",
+        response_model=List[Item],
+        tags=["items"],
+        operation_id="list_items",
+        openapi_extra={
+            "x-mcp-annotations": {
+                "readOnlyHint": True,
+                "openWorldHint": False,
+            }
+        },
+    )
     async def list_items(
         skip: int = Query(0, description="Number of items to skip"),
         limit: int = Query(10, description="Max number of items to return"),
@@ -25,7 +36,18 @@ async def list_items(
         """List all items with pagination and sorting options."""
         return items[skip : skip + limit]
 
-    @app.get("/items/{item_id}", response_model=Item, tags=["items"], operation_id="get_item")
+    @app.get(
+        "/items/{item_id}",
+        response_model=Item,
+        tags=["items"],
+        operation_id="get_item",
+        openapi_extra={
+            "x-mcp-annotations": {
+                "readOnlyHint": True,
+                "openWorldHint": False,
+            }
+        },
+    )
     async def read_item(
         item_id: int = Path(..., description="The ID of the item to retrieve"),
         include_details: bool = Query(False, description="Include additional details"),
diff --git a/tests/test_openapi_conversion.py b/tests/test_openapi_conversion.py
index aefe643..4282fbe 100644
--- a/tests/test_openapi_conversion.py
+++ b/tests/test_openapi_conversion.py
@@ -34,6 +34,22 @@ def test_simple_app_conversion(simple_fastapi_app: FastAPI):
         assert tool.description is not None
         assert tool.inputSchema is not None
 
+    # Verify annotations for list_items and get_item
+    list_items_tool = next(t for t in tools if t.name == "list_items")
+    assert list_items_tool.annotations is not None
+    assert list_items_tool.annotations.readOnlyHint is True
+    assert list_items_tool.annotations.openWorldHint is False
+
+    get_item_tool = next(t for t in tools if t.name == "get_item")
+    assert get_item_tool.annotations is not None
+    assert get_item_tool.annotations.readOnlyHint is True
+    assert get_item_tool.annotations.openWorldHint is False
+
+    # Verify no annotations for other operations
+    for tool in tools:
+        if tool.name not in ["list_items", "get_item"]:
+            assert tool.annotations is None
+
 
 def test_complex_app_conversion(complex_fastapi_app: FastAPI):
     openapi_schema = get_openapi(
@@ -59,6 +75,10 @@ def test_complex_app_conversion(complex_fastapi_app: FastAPI):
         assert tool.description is not None
         assert tool.inputSchema is not None
 
+    # Verify no annotations in complex_fastapi_app
+    for tool in tools:
+        assert tool.annotations is None
+
 
 def test_describe_full_response_schema(simple_fastapi_app: FastAPI):
     openapi_schema = get_openapi(
@@ -422,3 +442,36 @@ def test_body_params_edge_cases(complex_fastapi_app: FastAPI):
     if "items" in properties:
         item_props = properties["items"]["items"]["properties"]
         assert "total" in item_props
+
+
+def test_annotations_with_unknown_keys(simple_fastapi_app: FastAPI):
+    """
+    Test that unknown keys in x-mcp-annotations are handled gracefully.
+    The MCP ToolAnnotations model accepts extra keys for forward compatibility.
+    """
+    openapi_schema = get_openapi(
+        title=simple_fastapi_app.title,
+        version=simple_fastapi_app.version,
+        openapi_version=simple_fastapi_app.openapi_version,
+        description=simple_fastapi_app.description,
+        routes=simple_fastapi_app.routes,
+    )
+
+    # Add an unknown key to the annotations of list_items
+    list_items_path = openapi_schema["paths"]["/items/"]["get"]
+    list_items_path["x-mcp-annotations"]["unknownKey"] = "test_value"
+    list_items_path["x-mcp-annotations"]["anotherUnknown"] = 123
+
+    # This should not raise an error
+    tools, _ = convert_openapi_to_mcp_tools(openapi_schema)
+
+    list_items_tool = next(t for t in tools if t.name == "list_items")
+    assert list_items_tool.annotations is not None
+    assert list_items_tool.annotations.readOnlyHint is True
+    assert list_items_tool.annotations.openWorldHint is False
+
+    # Unknown keys should be preserved in the model's extra data
+    assert hasattr(list_items_tool.annotations, "unknownKey")
+    assert list_items_tool.annotations.unknownKey == "test_value"
+    assert hasattr(list_items_tool.annotations, "anotherUnknown")
+    assert list_items_tool.annotations.anotherUnknown == 123