The high mortality rate of diseases of the aorta has its foundation in imaging methods that define anatomy and disease burden but less so upon the diagnosis of asymptomatic conditions, rate of aneurysm expansion, or prediction of rupture. However, anatomical features can now be co-localized with molecular and physiological activity. The advancement of nanoparticles based upon iron oxide will also serve to bring a trio of magnetic, radionuclide, and optical imaging modalities together. The combinations of these technologies are still at the preclinical refinement stage but already enzyme-activatable probes have been used to interrogate different stages of aneurysmal disease. Like many disease areas where in vivo optical imaging may play a major role in the future, unravelling and management of aortic aneurysmal disease will progress through better understanding of its pathophysiology. This will translate into new clinical applications led by target-specific probes and the use of nanoparticle technology.