Multimodal imaging of acquired aortic diseases: clinical efficacy, comparative analysis, and future perspectives

Aortic diseases, particularly acute aortic syndromes (AAS) and aortic aneurysms (AA), represent critical cardiovascular conditions with high mortality rates requiring precise imaging for diagnosis and management. This review provides a comprehensive analysis of current imaging diagnostic techniques, focusing specifically on acquired thoracic and abdominal aortic pathologies. We first evaluate the comparative efficacy of Computed Tomography Angiography (CTA) and Magnetic Resonance Imaging (MRI) in the diagnosis of AAS (including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer), highlighting the role of artificial intelligence in optimizing segmentation and detection. Subsequently, we discuss aortic aneurysms, emphasizing the shift from simple diameter-based assessment to functional risk stratification incorporating calcification scoring, inflammatory imaging, and hemodynamic parameters. Furthermore, the review addresses postoperative imaging surveillance, particularly for endoleak detection following endovascular aneurysm repair (EVAR). We conclude that while CTA remains the gold standard for emergency diagnosis due to its speed and spatial resolution, MRI offers superior value in functional assessment and radiation-free long-term follow-up. The integration of multimodal imaging and AI-driven analysis is essential for achieving precision medicine in the management of acquired aortic diseases.