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Elucidating different pathologies within the likely heterogenous antibody-negative NMOSD\/MS overlap syndrome is, therefore, a major unmet need which would help avoid disability from inappropriate treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>In this study we aimed to identify distinct subgroups within the antibody-negative NMOSD\/MS overlap syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty-five relapsing antibody-negative patients with NMOSD features underwent a prospective brain and spinal cord MRI. Subgroups were identified by an unsupervised algorithm based on pre-selected NMOSD\/MS discriminators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four subgroups were identified. Patients from Group 1 termed \u201cMS-like\u201d (<jats:italic>n<\/jats:italic>\u2009=\u20096) often had central vein sign and cortical lesions (83% and 67%, respectively). All patients from Group 2 (\u201cspinal MS-like\u201d, 8) had short-segment myelitis and no MS-like brain lesions. Group 3 (\u201cclassic NMO-like\u201d, 6) had high percentage of bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM, 80% and 60%, respectively) and normal brain appearance (100%). Group 4 (\u201cNMO-like with brain involvement\u201d, 5) typically had a history of NMOSD-like brain lesions and LETM. When compared with other groups, Group 4 had significantly decreased fractional anisotropy in non-lesioned tracts (0.46 vs. 0.49,<jats:italic>p<\/jats:italic>\u2009=\u20090.003) and decreased thalamus volume (0.84 vs. 0.98,<jats:italic>p<\/jats:italic>\u2009=\u20090.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>NMOSD\/MS cohort contains distinct subgroups likely corresponding to different pathologies and requiring tailored treatment. We propose that non-conventional MRI might help optimise diagnosis in these challenging patients.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00415-021-10619-1","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T10:08:06Z","timestamp":1622110086000},"page":"269-279","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Elucidating distinct clinico-radiologic signatures in the borderland between neuromyelitis optica and multiple sclerosis"],"prefix":"10.1007","volume":"269","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5081-9677","authenticated-orcid":false,"given":"Maciej","family":"Jury\u0144czyk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"El\u017cbieta","family":"Klimiec-Moskal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yazhuo","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Hurley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Messina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianrong","family":"Yeo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Jenkinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Isabel","family":"Leite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Palace","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,27]]},"reference":[{"key":"10619_CR1","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1212\/WNL.53.5.1107","volume":"53","author":"DM Wingerchuk","year":"1999","unstructured":"Wingerchuk DM, Hogancamp WF, O\u2019Brien PC, Weinshenker BG (1999) The clinical course of neuromyelitis optica (Devic\u2019s syndrome). 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