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Objective: The aim of this study was to assess the ability of CT to predict the pathological nature of pancreatic cystic lesions if it is benign, malignant or premalignant. Methods: This is a retrospective study from the database of our hospital EMR (electronic medical records) for pancreatic lesions from patients who proven to be of pathological cystic nature. The diagnosis and characterization of pancreatic cysts were done by multislice 32 CT examination. We reviewed the data from the radiology, surgery and pathology departments from the period of November 2012 until January 2015. We compared between operative and pathological data and findings of MDCT using chi square test. Results: We reviewed the data from the radiology, surgery and pathology departments from the period of November 2012 until January 2015. The study was done on 66 patients. Our results showed that CT features for benign cystic lesions are lobulated shape and a thin wall (≤1 mm) while the round or oval shape or a complex cystic shape with tubular cyst and a thick wall (>1 mm) are more frequently seen in pancreatic premalignant and malignant macrocytic lesions. Conclusion: CT with thin section images allows adequate morphological characterization of macrocytic pancreatic masses that could predict its pathological nature if benign or malignant.