Odors are often difficult to identify, and can be perceived either via the nose or mouth (“flavor”; not usually perceived as a “smell”). These features provide a unique opportunity to contrast conceptual and perceptual accounts of synesthesia. We presented six olfactory-visual synesthetes with a range of odorants. They tried to identify each smell, evaluate its attributes and illustrate their elicited visual experience. Judges rated the similarity of each synesthetes’ illustrations over time (test-retest reliability). Synesthetic images were most similar from the same odor named consistently, but even inconsistently named same odors generated more similar images than different odors. This was driven by hedonic similarity. Odors presented as flavors only resulted in similar images when consistently named. Thus, the primary factor in generating a reliable synesthetic image is the name, with some influence of odor hedonics. Hedonics are a basic form of semantic knowledge, making this consistent with a conceptual basis for synaesthetic links.