To evaluate the diagnostic value of GeneXpert MTB/RIF for diagnosis of tuberculous meningitis (TBM). Methods: A total of 137 patients with suspected TBM were prospectively recruited. Samples of cerebrospinal fluid were collected from all patients, and tested by acid fast staining, mycobacterial culture and GeneXpert MTB/RIF. The performance of GeneXpert MTB/RIF was evaluated by two reference standards, clinical diagnosis and mycobacterial culture, respectively. Results: Of the 137 enrolled subjects, 124 cases (90.5% ) had a final diagnosis, with 51 cases being diagnosed definitive TBM and 73 cases being diagnosed non-TBM. When clinical diagnosis was used as the reference standard, the sensitivities of GeneXpert MTB/RIF? acid fast staining ? mycobacterial culture were 25.5% (13/51) ? 3.9% (2/51) ? 17.6% (9/51), respectively. The specificities of the three methods were all 100%. The sensitivity of GeneXpert MTB/RIF was comparable to that of mycobacterial culture (P=0.336), and was significantly higher than that of acid fast staining (P=0.002). When mycobacterial culture was used as the reference standard, the sensitivity of GeneXpert MTB/RIF was 88.9%，and specificity was 100% . Rifampin resistance was not found in the 13 positive results of GeneXpert MTB / RIF assay, which was consistent with traditional drug susceptibility test. Conclusion: GeneXpert MTB / RIF is a simple and rapid diagnostic method with high specificity for Mtb detection