Objective To investigate the value of transabdominal ultrasonography and multi-slice spiral CT (MSCT) in the diagnosis and differential diagnosis of female pelvic cystic lesions. Methods 76 patients with female pelvic cystic lesions who were treated in our hospital from January 2014 to December 2017 were enrolled in the study. All relevant imaging data of patients were collected.The postoperative results of biopsy were used as the diagnostic criteria, and the diagnostic accuracy of different examination for female pelvic cystic lesions was analyzed. Results The correct rate of MSCT in the diagnosis of pelvic cystic lesions was 95.35%, which was significantly higher than that of transabdominal ultrasonography (83.72%) (P<0.05). In the abdominal wall ultrasonography, the pelvic echinococcosis mainly showed thicker vesicle wall and a small amount of streak blood stream signals. There is no echo in the ovarian cyst, and color blood stream signals was seen in the papillary region of the capsule wall. Leiomyoma of uterus can be seen with low echo, with clear boundary, and there is a small amount of blood stream signals;In the MACT plain scan, the pelvic echinococcosis showed normality. In the plain scan of ovarian cysts, the wall was thin and even, and 18 of them showed obvious calcification and were gravel-like. Leiomyoma of uterus can be seen with a large mixed density and protrudes into the lower abdomen. The uterus can be moved to the side of the bond due to compression of fibroid. After further enhancement of scan, the cyst wall of pelvic echinococcosis is not calcification, with slight enhancement and it was curved. Ovarian cysts can be seen with obvious enhancement in the thickening and the bulge of the cyst wall, while the leiomyoma of uterus exhibits different degrees of enhancement in the arterial phase, and continues to show uneven enhancement in the venous phase and the delayed phase. Conclusion The advantage of MSCT in the diagnosis of female pelvic cystic lesions is more obvious, and the diagnostic accuracy is higher, which is more beneficial to improve the qualitative diagnosis rate of female pelvic cystic lesions.