|MRI with gadolinium showing diffuse dural enhancement|
Diffuse Dural Enhancement (DDE) is a finding on MRI scan of the brain. There is a white "high signal" ring around the brain corresponding to the location of the dura. It is usually detected using gadolinium, but a FLAIR imaging can also be used. (Tosaka et al, 2008)
According to River et al (1996), DDE is often associated with an underlying malignancy . Skull metastases and cranial nerve palsies are associated with malignancy (Chen et al, 2014; de Vasconcelos et al, 2011).
Other causes of DDE are related to cerebrospinal fluid (CSF) leak or shunting, with or without symptoms of intracranial hypotension (e.g. Tsui et al, 2001), and to dural sinus thrombosis and meningitis (Bhatia et al, 2009; Oiwa et al, 2004). Cases have also been reported from Wegeners (Levin et al, 2006). Blood patch may resolve DDE in cases of leaks (Gordon et al, 1995)