Objective To study image features and diagnostic value of multi-slice spiral CT and MRI in tuberculous meningitis (TMB). Methods 42 TMB patients treated in department of neurology and emergency department of our hospital from May 2013 to May 2016 were selected as the research objects, all patients underwent skull CT and skull MRI imaging examination, imaging performances were analyzed. Results Abnormal signs of multi-slice spiral CT and MRI imaging included meningeal thicking, cerebral infracted area, various degrees of hydrocephalus, abnormal density in basal cistern or suprasellar cistern or brain parenchyma and others, MRI diagnosis positive rate was 83.33%, which was significantly higher than multi-slice spiral CT (64.29%) (P<0.05). CT scan of most patients showed that there were hydrocephalus, cerebral infarction, solitary or multiple tuberculoma, anfractuosity or subarachnoid cistern narrowed down, cerebral hemorrhage, cistern narrow and occlusion and other abnormal changes, showed equidensity or slightly higher density shadow changes, some were accompanied by calcification; enhanced scan showed that most were cyclic annular or nodositas strengthen, few could not strengthen. MRI performance were shape of brain cisterns narrowed down or disappeared at the base of brain, T1 weighted image displayed equal signal or slightly higher signal, T2 weighted image displayed equal signal, meningeal thicking, enhancement scan showed that majority were involved in linear, punctiform, patchy, cyclic annular or nodositas strengthen, few could not strengthen; MRI performance of miliary tuberculose focus were T1-weighted images equal signal or low signal, center of lesions were high signal, they were multiple focal enhancement after strengthening. Conclusion Positive rate of MRI examination in the diagnosis of TBM is high, its combination with CT examination can provide accurate positioning and qualitative diagnosis of diseased region, implicative range, pathological types of TBM patients, improve clinical diagnostic accuracy.