Abstract Objective There is a need for prognostic biomarkers for risk assessment of small abdominal aortic aneurysm (AAA). Since CT textural analysis of tissue is a recognized feature of adverse biology and patient outcome in other diseases, we investigated it as a possible biomarker in small AAA. Methods Fifty consecutive patients (46-men, 4-woman, median-age 75y, range 56–85) with small AAA (3–5.5 cm) under surveillance undergoing serial ultrasound were prospectively recruited and assessed at baseline with CT texture analysis (CTTA) and18 F-Fluorodeoxyglucose positron emission tomography (18 F-FDG-PET). We followed forty patients (36-men, 4-woman, median-age = 74 y, range 60–85, participation rate = 80% for 1 year. For each axial image, CTTA using the filtration-histogram technique was carried out using a software algorithm that selectively extracts texture features of different coarseness (fine, medium and coarse) and intensity variation. Standard-deviation (SD) and kurtosis (K) at each feature-scale were measured. The maximum standardized uptake value (SUVmax ) of18 F-FDG in each axial image of the AAA was also measured with corrections for blood pool18 F-FDG activity to assess AAA metabolic activity. Specificity, sensitivity, and c-statistics were calculated with 95% confidence intervals for prediction of significant AAA expansion (≥2 mm) by CTTA measures before and after adjusting for clinical variables. Results The median aneurysm expansion at 12 months was 2.0 mm, (IQR 0.0–4.0). Coarse texture SD correlated inversely with AAA SUVmax ( rs  = −0.456, P  = 0.003). Medium coarse texture K correlated significantly with future AAA expansion adjusted for baseline size ( rs  = 0.343, P  = 0.030). AAA SUVmax correlated inversely with AAA expansion corrected for baseline size ( rs  = −0.383, P  = 0.015). Medium texture K was a strong predictor of significant AAA expansion (area under the Receiver-operating-characteristic (ROC) curve was 0.813) after adjusting for clinical variables. Conclusion We have shown evidence that CT signal heterogeneity measurements in small aortic aneurysm may be considered as a risk stratification tool in future prospective studies to identify aneurysms at risk of significant expansion. CT textural data appears to reflect AAA metabolism measured by PET.