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MR reveals large well-demarcated, lobulated heterogenous expansile mass within the left petrous apex. The lesion is hyperintense on T1WI, heterogeneously hypointense on T2WI, no diffusion restriction, and no enhancement after contrast administration. The lesion has a dark peripheral rim on T2WI due to hemosiderin.
Additionally, mass extends into the sphenoid sinus anteriorly, and invaded the left cerebellopontine cistern on the left and shows mass effect over the pons.
The findings are most suggestive of cholesterol granuloma of the left petrous apex.