Purpose To explore the CT features of renal cell carcinoma with cystic change and to compare them with pathological ifndings, so as to improve its diagnostic accuracy. Materials and Methods A retrospective study was carried out in 44 cases of renal cell carcinoma with cystic change conifrmed surgically and pathologically, among which 10 were multilocular cystic renal cell carcinoma, 21 were renal clear cell carcinoma and 13 were papillary renal cell carcinoma. The CT features of these 3 kinds of diseases were analyzed comparatively. Results All of 10 cases of multilocular cystic renal cell carcinoma appeared to have multilocular cysts with thin cystic walls and septa. The mean CT value of cyst was (15.8±5.6) HU. The diameter of wall nodule was larger than 5 mm in 4 cases. The contrast-enhanced CT scan showed that the cystic walls and septa had early moderate enhancement in 8 cases. Among 21 cases of renal clear cell carcinoma, 9 presented to have multilocular cysts with thick cystic walls and septa. The mean CT value of cyst was (32.5±6.7) HU. The diameter of wall nodule was larger than 5 mm in 19 cases. The cystic walls and septa had obvious early enhancement in 20 cases. As to the 13 cases of papillary renal cell carcinoma, 4 appeared to have multilocular cysts with thick cystic walls and septa. The mean CT value of cyst was (26.1±5.6) HU. The diameter of wall nodule was larger than 5mm in 12 cases, and 12 cases appeared to have slight to moderate delayed enhancement. Conclusion The CT features of renal cell carcinoma with cystic change could be used in differential diagnosis, such as with or without pseudocapsule, mean CT value of cyst, thickness of cystic wall and septum, size, boundary, and enhancement of nodule.