Clinical management of abdominal aortic aneurysm (AAA) disease is based on the maximal diameter. Vascular inflammation and intraluminal thrombus (ILT) composition have been explored as novel imaging markers of progressive AAA disease, but studies to date have been limited by short follow-up time (~6 month). We followed 37 patients for an average of 4 years using CT/CTA and high resolution black-blood MRI. Our results show that inflammation identified by delayed ultrasmall superparamagnetic iron oxide (USPIO) particle uptake was strongly associated with AAA growth and/or intervention, whereas ILT composition was not. Imaging of vascular inflammation may improve AAA patient risk stratification.