Aorta unveiled: the crucial role of imaging in diagnosing and managing aortic disease-a review.

Abstract

Aortic diseases, including aneurysmal and occlusive pathologies of the thoracic and abdominal aorta, represent a significant source of cardiovascular morbidity and mortality. This narrative review explores the role of modern and emerging imaging modalities in the management of aortic disease and highlights the pivotal roles of computed tomography angiography (CTA), magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS). CTA remains the cornerstone for evaluating aneurysms, dissections, and traumatic injuries, offering high spatial resolution, rapid acquisition, and detailed anatomical assessment. MRI, particularly with advanced sequences such as 4D flow, provides comprehensive multiparametric evaluation without radiation exposure, making it ideal for younger patients and those requiring repeat imaging. Positron emission tomography (PET), especially when integrated with CTA or MRI, enables metabolic characterization of inflammation and infection in aortic walls. Ultrasound, particularly CEUS, remains indispensable in abdominal aortic aneurysm (AAA) screening and post-endovascular aortic aneurysm repair (EVAR) surveillance, especially in patients with renal impairment. Emerging technologies, including hybrid imaging, radiomics, and artificial intelligence (AI) are reshaping the landscape of aortic diagnostics. These innovations enhance detection of subtle imaging features, automate measurements, and may enable prediction of disease progression or complications.