The diagnostic criteria for optic neuromyelitis spectrum diseases propose six core clinical features, including optic neuritis, acute myelitis, posterior region syndrome, acute brainstem syndrome, symptomatic sleep attacks or acute diencephalic syndrome with typical diencephalic MRI lesions, and symptomatic brain syndrome with typical brain MRI lesions, among which imaging plays an important role. This article aims to explore the imaging changes corresponding to its six core clinical features and analyze the differential diagnosis of common diseases, so that imaging and neurologists can better understand and master the diagnostic criteria of optic neuromyelitis spectrum diseases.