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<p><strong>Objective</strong> To assess the diffusion changes of normal appearing spinal cord (NASC) in MRI examination in patients with neuromyelitis optica (NMO) and multiple sclerosis (MS).  <strong>Methods</strong> Axial diffusion tensor imaging (DTI) of cervical cord was performed in 10 patients with NMO, 14 patients with MS and 13 sex- and age-matched healthy controls. Mean diffusivity (MD) and fractional anisotropy (FA) were measured in the C_2-5 level of spinal cord. Regions of interest (ROIs) were placed in the anterior, lateral, posterior funiculi of spinal cord, and the central gray matter of spinal cord. <strong> Results</strong> Compared with healthy controls, the values of FA in anterior, lateral and posterior funiculi of spinal cord were significantly decreased (<em>P </em>&lt; 0.05, for all) and MD in left lateral funiculus, posterior funiculus and gray matter were significantly increased (<em>P</em> ≤ 0.05, for all) in NMO group, and the FA values of right lateral and posterior funiculi in MS group were significantly decreased (<em>P</em> &lt; 0.05, for all). Compared with MS group, FA value in patients with NMO was significantly decreased in lateral funiculus, and MD value in left lateral and right posterior funiculi were significantly increased (<em>P</em> &lt; 0.05, for all).  <strong>Conclusions </strong> NASC diffusion abnormalities were found both in patients with NMO and MS. The difference of DTI indicators between NMO and MS patients may offer important information in the early diagnosis and differential diagnosis of NMO and MS.</p><p> </p><p><strong>doi: </strong>10.3969/j.issn.1672-6731.2014.10.007</p>