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Fig. 2A —70-year-old woman with suspected subclavian steal syndrome and flow reversal on Doppler sonography. Occlusion is seen within left subclavian artery proximal to veterbral artery origin, shown on high-resolution 3D contrast-enhanced MR angiography (CEMRA) maximum-intensity-projection (MIP) image. The left vertebral artery appears normal (A). The normal left vertebral artery can also be seen on axial reformat of data (B). Corresponding reformatted MIP (C) and axial (D) images from 2D time-of-flight localizer show flow void in left vertebral artery, despite visualization of normal right vertebral artery on 3D CEMRA. This indicates flow reversal within vertebral artery ("localizer" sign).