A 42 year-old female presented with bilateral arm fatigue, worse with lifting above the head . Physical examination showing absent radial pulses, and serum inflammatory markers including erythrocyte sedimentation rate and c-reactive protein levels were elevated. Anemia was also present (hematocrit 30%). With a presumptive diagnosis of Takayasu arteritis, treatment with prednisone was initiated and CE-MRA was requested. A. Volume rendering shows patency of the common brachiocephalic trunk (C); the proximal portion of the left subclavian artery (L SC, arrow) is patent while distally it is occluded (open arrow). B. Maximum intensity projection (MIP) shows reconstitution of the distal L SC (arrows) via collaterals. C. Similarly, a MIP image shows that the right subclavian artery is occluded (open arrow) and fills distally (filled arrows) via collaterals. D. Volume rendering demonstrates high-grade stenosis (arrow) of the left vertebral artery (V).